Experience and Education
High school diploma or equivalent (Bachelor's degree preferred) and 7 years professional revenue cycle working experience, including: 4 years medicine, ancillary, or surgical coding; 1 year clinical and or technical denials management/prevention; and 3 years progressive management in health care administration, physician group practice, and/or claims processing is required. Ability to demonstrate w ork experience producing positive results in a 100% metric driven work environment . Advanced degree (Bachelor's or Master's) may be considered in lieu of experience. Professional Coding Certification (e.g., CPB, CPC, CCS-P) preferred.
- Accountable and responsible for the clinical denial prevention and management program for either the centralized Medicine and Ancillary or Surgical revenue cycles in a collections metric driven environment. Monitor appeal effectiveness and denial prevention efforts by reviewing Epic work queues and reports, MS Excel remit code level reports, and the Epic staff note payment percentage report. Monitors Epic follow-up work queue automation rules to ensure they are functioning correctly and or if adjustments or new rules need to be written. Conducts analysis of denials and denial trends by type and payor. Monitors payor reimbursement policies to prevent future claim denials and or internal denial routing for correct and prompt resolution.
- Coordinates, with supervisor, the appeals process for all balances deemed appropriate. Facilitates payor denials related communication with revenue cycle operations staff, clinical operations staff, and Revenue Cycle Operations management.
- Works with staff to identify the root cause of denials and to implement effective strategies and process improvements, to reduce costly delays in payment. Assures prompt action is taken on denials by coordinating with supervisor/staff to create written and/or verbal clinical appeals with payers.
- Formulates letters of appeal. Ensuring they include relevant and effective clinical documentation from the medical record; supported by current industry clinical guidelines, evidence based medicine, local and national medical management standards and clinical protocols.
- Actively participates in the University Edit Administration Committee to ensure accountability for denials reduction performance, and ensures compliance with all governmental regulations and non-governmental guidelines.
- Maintains and applies an excellent understanding of physician reimbursement policy and coding methodologies including, but not limited to AMA, CMS and specialty societies to ensure physician practice revenue integrity and compliant documentation and coding.
- Performs other duties as assigned.
Knowledge, Skills & Abilities W ork requires working knowledge of insurance billing and various types of health insurance plans.
Work requires working knowledge of medical terminology and coding.
Work requires excellent customer service relationships to ensure patient satisfaction.
Work requires demonstrated ability to handle escalated or complex customer inquiries.
Work requires demonstrated ability to understand written medical and billing documentation.
Work requires demonstrated ability to communicate effectively with various levels of constituents, patients and/or family, clinical staff, third party payers, management and other professionals outside the healthcare system.
Work is performed in a professional office setting, with a fast-paced, production-oriented environment.
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information
Salary Salary Negotiable
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; sex; including sexual harassment; age; disability; genetic information; citizenship status; and protected veteran status. In addition, it is UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.