WHY UT SOUTHWESTERN?
With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you’ll discover a culture of teamwork, professionalism, and a rewarding career!

JOB SUMMARY

UT Southwestern has an amazing leadership opportunity available in the Revenue Cycle Department team. The successful applicant’s duties will include but is not limited to the following: 

• Manage two (2) supervisors and a team of clinical denials specialists. 
• Responsible for the management of clinical denials, across all payors Will work to assure optimal reimbursement for professional services rendered by UTSW providers.
• Must know EPIC. 
• Must be a critical thinker and analytical person. 
• Ability to lead/manage a team. 

Work From Home (WFH): This is 100% work from home position. DFW metroplex candidates strongly preferred. Unable to consider those residing outside of the state of Texas. Additional details regarding WFH will be discussed during the interview.

Shift: 8-hour days, Monday through Friday

BENEFITS
UT Southwestern 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% coverage for preventive healthcare-no copay
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer
• Learn more about these and other UTSW employee benefits!

EXPERIENCE AND EDUCATION
Required

• Education
  High School Diploma Or equivalent 

• Experience
  7 years of professional revenue cycle working experience; including
  4 years of medicine, ancillary, or surgical coding
  1 year of clinical and or technical denials management/ prevention
  3 years of progressive management in health care administration, physician group practice, and/or claims processing and
  Manager experience must include producing positive results in a 100% metric driven work environment
  Advanced degree(s) (Bachelors, Masters) may be considered in lieu of experience.

Preferred

• Education
  Bachelor’s Degree

• Licenses and Certifications
  Professional Coding Certification Upon Hire

JOB DUTIES

• 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.

SECURITY AND EEO STATEMENT

Security
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

EEO Statement
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.