Billing Specialist III

UT Southwestern Medical Center•Dallas, TX

1d•Remote

About The Position

Works under moderate supervision to perform advanced level billing responsibilities. This position is needed to work Cardiology charge review WQs to make sure all service lines are worked to meet 6-day metrics. Assign CPT, ICD, and modifiers and resolve edits. Work From Home (WFH): This position is a WFH opportunity. Must live in Texas. Additional details to be discussed during the interview Shift: 8-hours, flex shift 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%25 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!

Requirements

High School Diploma or equivalent.
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

Nice To Haves

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.
(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

Responsibilities

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.

Benefits

PPO medical plan, available day one at no cost for full-time employee-only coverage
100%25 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

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