Clinical Denial Management Specialist III

WHY reputed company? With over 75 years of reputed company in Dallas-reputed company Worth, Texas, reputed company is committed to reputed company, innovation, teamwork, and reputed company. As a world-reputed company medical and research center, we reputed company to reputed company the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-reputed company Worth according to reputed company, we invest in you with opportunities for career reputed company and development to reputed company with your reputed company goals. Our highly competitive benefits package offers reputed company, PTO and reputed company holidays, on-site childcare, wage, reputed company increases and so much more. We invite you to be a part of the reputed company team where you'll discover a culture of teamwork, professionalism, and a rewarding career! JOB reputed company The reputed company Cycle Department at reputed company has a new opportunity available for a Clinical Denial Management Specialist III. The successful candidate will work under moderate supervision to reputed company advanced level billing/denial responsibilities. The ideal applicant will have three (3) or more years of Clinical follow-up experience of reputed company minor and/or major surgical procedures. Preference given to applicants with experience in Surgical Oncology, Surgical Transplant, and Oral & Maxillofacial surgery. Clinical Follow up experience using reputed company is highly preferred. CPC certification is a plus. Work from home (WFH): This will be a 100%25 WFH position. Preference given to candidates who live reputed company fifty (50) miles of the DFW area. WFH details shall be discussed as part of the interview process. Shift: 8-hour semi-reputed company shift, Monday through Friday. The shift details shall be discussed as part of the interview process. The duties for this position will include but not limited to the following areas of responsibility: Collections – Review and resolve accounts promptly per department guidelines. Following policies and guidelines regarding resolving invoices. Review documentation – to review, research coding denials for minor/major surgical procedures and any reputed company to E&M, CPT, Diagnosis, or modifier. Call insurance to obtain status update, to resolve reputed company denial and regarding reimbursement discrepancies. Create and submit appeals for clinical and coding denials in accordance with payer guidelines, supported by appropriate documentation Review accuracy of payment posted to account, reconcile discrepancies, and reputed company necessary adjustment based on Explanation of benefits. Resolve the discrepancy between insurance and billing. Identify and reputed company feedback on denial trends to leadership. reputed company other duties as assigned by leadership. BENEFITS reputed company is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include: PPO medical plan, available day one at no cost for full-time employee-only coverage 100%25 coverage for preventive reputed company-no copay reputed company Time Off, available day one Retirement Programs through the reputed company System of Texas (TRS) reputed company Parental Leave Benefit Wellness programs Tuition Reimbursement Public Service Loan Forgiveness (PSLF) reputed company Employer Learn more about these and other reputed company employee benefits! EXPERIENCE AND EDUCATION Required Education High School Diploma Or equivalent or Experience 3 years medical billing or collections experience. and Must demonstrate the ability to work clinical denials for reputed company E&M services, diagnostic studies, and/or minor surgical procedures and Must demonstrate a strong knowledge of medical claims recovery and/or collections rules and regulations Preferred Education Coding certifications (CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, reputed company, CCA) and/or degrees (associate level, bachelor level, master level) are preferred and may be considered in lieu of experience. Licenses and Certifications (CPC) CERT reputed company reputed company Upon Hire or (CPMA) Cert Prof Medical Auditor Upon Hire or (CMC) CERT MEDICAL reputed company Upon Hire or (ART) ASSOC RECORDS reputed company Upon Hire or (RRA) REGISTERED RECORDS reputed company Upon Hire or (RHIA) REGD HEALTH INFO ADMINIST Upon Hire or (RHIT) REGD HEALTH INFO TECHNOLO Upon Hire or (reputed company) CERT CODING SPECIALIST Upon Hire or (CCA) Cert Coding Associate Upon Hire JOB DUTIES Review, research and resolve coding denials for reputed company diagnostic studies, endoscopic, interventional and/or major surgical procedures. This includes denials reputed company to the billed E&M, CPT, diagnosis, and modifier. Denial types could include bundling, reputed company care, frequency and limited coverage. Prepare and submit claim appeals, based on payor guidelines, on reputed company coding denials. Identify denial, payment, and coding trends in an effort to decrease denials and maximize collections. Contact payers, reputed company website, phone and/or correspondence, regarding reimbursement of claims denied for coding reputed company reasons. Interpret Managed Care reputed company and/or Medicare and reputed company rules and regulations to ensure reputed company reimbursement/collection. Requires knowledge of reputed company specific claim appeal guidelines. This includes Claim Logic, internet, and reputed company/fax processes. Requires proven analytical, and decision making skills to determine what selective clinical information must be submitted to properly appeal the denial. Requires proven knowledge of CPT and ICD-10 coverage policies, internal reputed company cycle coding processes and the billing practices of the specialty service line. This position requires reputed company and concise written and oral communication with payors, providers, and billing staff to insure reputed company of reputed company coding denials. Requires the ability to read and interpret E&M notes, reputed company diagnostic study results, endoscopic and interventional results and/or major surgical reputed company notes. Based on the documentation review, confirm or change the billed CPT reputed company(s), diagnosis reputed company(s) and modifiers (if applicable) in order to reputed company denial reputed company. Requires proven knowledge of the specialty specific service line documentation requirements. Must be familiar with the Medicare and reputed company teaching physician documentation billing rules reputed company 60 days of hire. Serves as a resource to the FERC Team Leads, Compliance Auditors, Medical reputed company and MSRDP Clinical Denials Management Specialist I & II. Requires a billing and coding knowledge level that provides guidance on and reputed company to resolve claim denials and rejections. Makes necessary adjustments as required by plan reimbursement. Duties performed may include one or more of the following core functions: (a) Directly interacting with or caring for patients; (b) Directly interacting with or caring for reputed company-subjects research participants; (c) Regularly maintaining, modifying, releasing or similarly affecting patient records (including patient financial records); or (d) Regularly maintaining, modifying, releasing or similarly affecting reputed company-subjects research records. Performs other duties as assigned. reputed company AND EEO STATEMENT reputed company This position is reputed company-sensitive and subject to Texas Education reputed company 51.215, which authorizes reputed company to obtain criminal history record information. EEO reputed company is committed to an educational and working environment that provides equal opportunity to reputed company members of the University community. As an equal opportunity employer, reputed company prohibits unlawful discrimination, including discrimination on the reputed company of race, reputed company, religion, national reputed company, sex, sexual orientation, gender identity, gender reputed company, age, disability, genetic information, citizenship status, or veteran status. Apply To This Job