Claims Edit Specialist-MSRDP
Job Number: 362510
Location: 5323 Harry Hines Blvd, Dallas, TX
Department: 713007 - MG Rev Cyc-Surg Follow-Up
Full/Part Time/PRN: Day Job
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
Associates degree and three (3) years’ experience with medical billing or claims processing, knowledge of billing and/or collections rules and regulations; or
High school diploma or equivalent and five (5) years’ experience with medical billing or claims processing, knowledge of billing and/or collections rules and regulations is required.
- Reviews and processes complex insurance claim edits through the billing system for CPT, diagnosis, and authorization accuracy in a timely manner.
- Utilizes vendor and third party websites for eligibility/benefit verification and authorization information. Updates the billing system accordingly.
- Reposts and resubmits claims based on research findings and billing system updates.
- Assists lower level specialists. May escalate issues above knowledge base to higher level specialist or supervisor.
- 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 ability to work in a fast paced, production oriented environment.
- Strong knowledge of CPT, HCPCS and ICD-10 coding
- Strong knowledge of medical terminology, rules and regulations affecting healthcare reimbursement and insurance carrier adjudication policies/procedures
- Work requires basic working knowledge of spreadsheet and word processing software; good analytical skills.
- Work requires strong organizational skills
- Work requires good oral and written communication skills.
Work is performed primarily in a general office environment.
UTSouthwestern 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 UTSouthwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.