Job description

JOB SUMMARY:
UT Southwestern Medical Center has an opening within the Department or Revenue Cycle for a Billing Specialist III. The duties of this positon will include but not be limited to the following:

Review and resolve outstanding claims
Determine root causation why claims are fall into WQ
Calling insurance, appealing claims, reviewing EPIC WQ rules and logic

This position will be a work from home job, however, exact details related to this are to be discussed during the interview process.

EXPERIENCE/EDUCATION:
REQUIRED:
High School diploma and three (3) years medical billing or collections experience.

Must demonstrate the ability to work complex E&M services, complex diagnostic studies, endoscopic, interventional and/or surgical procedures.

Must demonstrate the ability to make calls to obtain authorizations.

Coding certifications (CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS, CCA) and/or degrees (associate level, bachelor level, master level) preferred and may be considered in lieu of experience.

JOB DUTIES:
Analyzes, investigates, and resolves coding edits for complex drug billing, complex diagnostic studies, endoscopic, interventional and/or surgical procedures. This includes CPT, diagnosis, modifier, bundling, duplicate charge, and custom edit resolution. Requires strong knowledge of the carrier’s (Federal/State/Private) regulations and guidelines, internal revenue cycle coding processes and specialty specific service line billing practices. This position requires a high degree of organization and accuracy, and clear communication with providers on a regular basis to insure services are well documented and meet all billing requirements. This position could possibly require resolving clinical and/or technical denials as well.

Performs abstracting on E&M services, complex diagnostic studies, and/or endoscopic, interventional, or surgical procedures. Requires the ability to read the progress note and or procedure/surgical results and confirm or change the CPT code(s), diagnosis code(s) and modifiers (if applicable). Requires strong knowledge of the carrier coverage policies and documentation requirements for specialty specific service lines. Must know the Medicare and Medicaid teaching physician documentation billing rules.

Perform monthly charge reconciliation.

Serves as a resource to the FERC Team Leads, Compliance Auditors, Medical Collectors and Billing Specialists I & II. Requires a billing and coding knowledge level that provides guidance on and resolution to resolve claim denials, rejections, and backend coding edits.

Performs manual charge entry for all non-EpicCare and non-automated sites of services. This includes E&M visits and procedures across several centralized service lines. Depending on the clinical department they may be required to review and release charges from a computer assisted coding environment.

Investigates and resolves coding and registration Epic Resolute Claim edits. Requires strong knowledge of Epic’s carrier registration filing order rules and billing rules.

Periodically assists in obtaining insurance authorizations and accurately maintaining the authorization records, communicate patient balance and patient-responsibility amounts to clinics and/or patient/families, responding to requests for information. Attend coding and billing in-services to stay current on changes; attend other meetings and training as assigned.

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 human-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 human-subjects research records.

Performs other duties as assigned.

KNOWLEDGE, SKILLS & ABILITIES:
Work requires working knowledge of Epic Resolute, EpicCare, and Epic CPOE.

Work requires working knowledge of MS Excel.

Work requires ability to analyze problems, develop solutions, and implement new procedures.

Work requires ability to prioritize large volumes of work.

Work requires good communication skills.

WORKING CONDITIONS:
Work is performed primarily in general office/clinic area. Security: This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information

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.

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