Billing Specialist II - Pathology
Categories: Insurance / Billing
Full/Part Time/PRN: Full-Time
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information
Experience and Education
1. High School diploma or equivalent; Associates degree preferred. Four (4) years medical billing or collections experience. One (1) year must include billing and or denials management for complex E&M services, diagnostic studies, and/or minor surgical procedures. Requires working knowledge of Epic Resolute, EpicCare, and Epic CPOE.
2. Certified Professional Coder (CPC), Advanced Records Technician (ART), or Registered Records Administrator (RRA) preferred.
1. Analyzes, investigates and resolves coding edits for E&M services, diagnostic studies, and minor surgical procedures. This includes CPT, diagnosis, modifier, bundling, duplicate charge, and custom edit resolution. Requires knowledge of the carrier's (Federal/State/Private) regulations and guidelines, internal revenue cycle coding processes and be familiar with the billing practices of the specialty service line. This position requires a high degree of organization and accuracy and requires clear communication with providers on a regular basis to insure visits are well documented and meet all billing requirements.
2. Performs limited abstracting on E&M services, diagnostic studies, and moderate to minor surgical procedures. Requires the ability to read the progress note and or procedure results and confirm or change the CPT code(s), diagnosis code(s) and modifiers (if applicable). Requires knowledge of the carrier coverage policies and be familiar with the billing practices of the specialty service line. Must be familiar with the Medicare and Medicaid teaching physician documentation billing rules.
3. Investigates and resolves coding and registration Epic Resolute Claim edits. Requires strong knowledge of Epic's carrier registration filing order rules and billing rules.
4. 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.
5. 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.
6. 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.
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; gender, including sexual harassment; age; disability; citizenship; and veteran status. In addition, it is UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.