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Research Billing Specialist Sr - MG Rev Cyc-Med Front End

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Job Number: 101118
Category: Insurance/Billing
Location: 5323 Harry Hines Blvd, Dallas, TX
Department: 713002 - MG Rev Cyc-Med Front End
Full/Part Time/PRN: Day Job
Regular/Temporary: Regular
Schedule: Full-time

Experience and Education


High School diploma or equivalent, Associates degree preferred, and six (6) years medical billing or collections experience. Three (3) years must include billing for research and clinical trial services. Experience involving complex diagnostic studies, endoscopic, interventional and/or surgical procedures preferred. Requires working knowledge of Velos (or other research/clinical trials management system), Epic Resolute, and EpicCare. Certified Professional Coder (CPC), Advanced Records Technician (ART), or Registered Records Administrator (RRA) preferred.

Job Duties


  1. Reviews professional charges daily that are in the Epic charge router review work queues, charge review work queues, Epic generated reports and or Microsoft Excel files and segregates them as standard-of-care services, research-related services, or indeterminate services. Standard-of-care ensure the service(s) are moved to the patients Epic personal/family guarantor account. Research-related ensure the service(s) are moved to the research guarantor account.

  2. For charges that are identified as indeterminate, this position must utilize the Velos system, UTSW, CMC, or PHHS Epic systems (Patients needing research billing review report) and clinical orders. This position must also work with research study coordinators, research compliance coordinators, research principle investigators, transplant billing coordinators, the UTSW clinical research services office, and or the sponsored programs administration to determine if the service(s) are standard-of-care or research-related.

  3. Consistently monitors the routing of charges to ensure the routing rules are working correctly and the work queues are receiving charges appropriately. Works with UTSW HSIR to modify and test changes to the charge routing rules when appropriate.

  4. Serves as a research and clinical trials resource to all university professional billing revenue cycle teams.

  5. 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.

  6. Performs other duties as assigned.

Knowledge, Skills & Abilities


  • Work requires working knowledge of Epic Resolute, EpicCare, and Epic CPOE .

  • Work requires working knowledge of MS Excel.

  • Work requires ability to analyze problems, develop solutions, and clearly communicate recommendations to supervisor.

  • Work requires the ability to prioritize and handle large volumes of work.

  • Work requires strong knowledge of Federal/State/Private payor general coverage principles, clinical trial policies, research and clinical trials investigating medical device policies, billing regulations and guidelines, and especially the Medicare July 2007 NDC Routine Costs in Clinical Trials (310.1) document.

  • Work requires a working history with the Clinical Research Management System (CRMS) called Velos eResearch system and applying the documented coverage analysis to billed professional clinical services.

  • Requires a working knowledge of how to apply routine and investigational clinical services modifiers and diagnosis coding.

  • Work requires a high degree of organization and accuracy, and clear communication with all research and clinical trial stakeholders.

  • Work requires good communication skills.

    Working Conditions


    Work is performed primarily in general office/clinic area.

Security


This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT

Southwestern to obtain criminal history record information

Salary


Salary Negotiable

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.

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