Clinical Denial Management Specialist I-MG Revenue Cycle-Med Follow-Up


Job Number: 374841
Category: Insurance/Billing
Location: 5323 Harry Hines Blvd, Dallas, TX
Department: 713008 - MG Rev Cyc-Med Follow-Up
Full/Part Time/PRN: Day Job
Regular/Temporary: Regular
Schedule: 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


Salary Negotiable

Experience and Education

High School diploma or equivalent and two (2) years medical billing or collections experience. Requires working knowledge of Epic Resolute.

Job Duties

1.Review, research and resolve basic coding denials. This includes denials related to the billed E&M, CPT, diagnosis, and modifier. Denial types could include bundling, concurrent care, frequency and limited coverage. Prepare and submit claim appeals, based on payor guidelines, on basic coding denials. Identify denial, payment, and coding trends in an effort to decrease denials and maximize collections.
2.Contact payers, via website, phone and/or correspondence, regarding reimbursement of claims denied for coding related reasons. Interpret Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection.
3.Makes necessary adjustments as required by plan reimbursement.
4.Attend coding and billing in-services to gain proven knowledge of CPT and ICD-10 coverage policies, internal revenue cycle coding processes and the billing practices of specialty service lines.
5.Requires knowledge of carrier specific claim appeal guidelines. This includes Claim Logic, internet, and or paper/fax processes.
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.

**Other Duties: Performs other duties as assigned.

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.