Billing Specialist III - Medicine and Ancillary Front End
Categories: Insurance / Billing
Department: MSRDP Front End Revenue Cycle
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
High School diploma or equivalent, Associates degree preferred, and six (6) years medical billing or collections experience. Two (2) years must include billing and or denials management for complex E&M services, diagnostic studies, and/or minor surgical procedures. Experience involving complex diagnostic studies, endoscopic, interventional and/or surgical procedures preferred. Requires working knowledge of Epic Resolute, EpicCare, and Epic CPOE. Certified Professional Coder (CPC), Advanced Records Technician (ART), or Registered Records Administrator (RRA) preferred.
1. Analyzes, investigates and resolves coding edits for 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.
2. 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.
3. 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.
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. Investigates and resolves coding and registration Epic Resolute Claim edits. Requires strong knowledge of Epic's carrier registration filing order rules and billing rules.
6. 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.
7. 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.