Billing Specialist III

Work from home (WFH): This position is slated to work from home, including training. Candidates must live within the Greater DFW area. Additional details shall be discussed as part of the interview process.

Shift: Flex, 8-hour shift beginning between 0600-0900

JOB SUMMARY:

The Revenue Cycle Billing Specialist III is a crucial member of our team, responsible for reviewing and resolving outstanding claims within the revenue cycle process. This role involves a comprehensive understanding of billing procedures, insurance protocols, and revenue cycle management software, particularly Epic. The primary duties include investigating and resolving claims that are held in the Epic Work Queue (WQ), through methods such as calling insurance companies, appealing claims, and analyzing Epic WQ rules and logic. The Level III position also entails identifying the root cause of claims being held in the WQ and collaborating with the Information Resource department to establish or update routing rules within the system. Furthermore, the incumbent will provide insights and guidance to leadership on strategies to prevent future claims from falling into the WQ, thereby optimizing revenue flow. In addition to resolving claims, the Revenue Cycle Billing Specialist III will play a pivotal role in training new staff members on navigating and resolving issues within the Epic WQ. Therefore, proficiency in training methodologies and a strong understanding of registration, follow-up, coding, and Epic systems are essential. The ideal candidate will demonstrate adaptability, a quick learning aptitude, and a strong work ethic to effectively fulfill the responsibilities of this role.

OUR CULTURE:

Our teams culture is Love Based, which thrives on mutual respect, empathy, and support, fostering an environment where every member feels valued and empowered. It prioritizes open communication, collaboration, and understanding, creating a cohesive and inclusive community where individuals can flourish personally and professionally. Love Based cultivates a culture where kindness, compassion, and appreciation are foundational principles, leading to greater creativity, productivity, and fulfillment for all team members.

JOB EXPECTATIONS:

• Work both independently and collaboratively within a team to achieve production goals and deadlines.
• Demonstrate a strong commitment to productivity by staying focused and on task without constant supervision.
• Effectively communicate with colleagues, supervisors, and manager to ensure clarity, alignment, and successful outcomes.
• Take ownership of assigned tasks and projects, demonstrating accountability and reliability in meeting expectations.
• Adapt to changing priorities and work demands while maintaining a high level of quality and efficiency.
• Proactively identify opportunities for process improvement and contribute innovative solutions to enhance overall productivity and teamwork
• Ability to contact medical insurance payer and resolve outstanding claims
• Ability to appeal denied claim and overturn the denial.

HARD SKILLS

• Experience with Epic Follow-up WQ logic and routing rules.
• Experience working with Information Resources on outstanding IR Tickets to update or create new routing logic.
• Experience with Reconsideration, Redetermination, and Appeal with health insurance carriers.
• Knowledge and experience with handling and resolving NCCI edits, LCD/NCD, and bundling denials.
• Knowledge and experience with denial codes from the remittance/EOB
• Knowledge and experience with contacting health insurance carriers
• Ability to read and understand Explanation of Benefits
• Ability to multitask
• Contacting insurance companies and patients Knowledge and experience with online payer portals Epic experience Experience with reviewing medical records Soft Skills Outlook experience Outlook Teams App experience Excel experience Medical Terminology Payer Portal experience

EXPERIENCE | EDUCATION:

REQUIRED:

• High School diploma.
• And three (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.
• 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.

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 multiple specialties 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.

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 implement new procedures.
• Work requires ability to prioritize large volumes of work.
• 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

UT Southwestern 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 UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.