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
Works under moderate supervision to perform advanced level billing responsibilities. 

UT Southwestern Medical Center has an opening within the Revenue Cycle Department team for a Billing Specialist III.  Works under moderate supervision to perform advanced level billing responsibilities. The successful candidate’s experience should include but is not limited to the following skills:

• Capable of reviewing Explanation of Benefits (EOB) from payors to determine how the claims were managed.
• Contacting insurance carriers to check on the status of claims, appeals, and insurance verification.
• Review, research and resolve claim denials and appeals for various insurance companies while identifying payment trends in an effort to maximize collections.
• Knowledgeable with payors including Managed Care, Commercial, Medicare, and Medicaid
• Preparing/Submitting appeals related to denied services.

This is a work from home (WFH) opportunity. The successful applicant must live within the Greater DFW area and be available to come to the office for equipment pickup, office meetings, and training. Additional details regarding WFH will be discussed as part of the interview process. 

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
  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 

Preferred

• Education
  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. 
   

• Licenses and Certifications
  (CPC) CERT PROFESSIONAL CODER Upon Hire or
  (CPMA) Cert Prof Medical Auditor Upon Hire or
  (CMC) CERT MEDICAL CODER Upon Hire or
  (ART) ASSOC RECORDS ADMIN Upon Hire or
  (RRA) REGISTERED RECORDS ADMIN Upon Hire or
  (RHIA) REGD HEALTH INFO ADMINIST Upon Hire or
  (RHIT) REGD HEALTH INFO TECHNOLO Upon Hire or
  (CCS) CERT CODING SPECIALIST Upon Hire or
  (CCA) Cert Coding Associate Upon Hire 

  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.
• May assist 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.
• May lead train, and/or mentor the work of lower-level designated coding employees to ensure quality of work and growth in knowledge and expertise.
• May support mulitple specialities in a hybrid role as needed.
• 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.

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
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.