Manager, Clinical Denials - Revenue Cycle

JOB SUMMARY:
UT Southwestern has an amazing leadership opportunity available in the Revenue Cycle Department team. The successful applicant in this position duties will include but not be limited to the following:
Manage two (2) supervisors and a team of clinical denials specialists.
Will have colleague in same role, with similar team structure.
Responsible for the management of clinical denials, across all payors
Will work to assure optimal reimbursement for professional services rendered by UTSW providers
Must know EPIC.
Must be a critical thinker and problem solver.
Ability to lead/manage a team
This is a 100% work from home position. DFW metroplex candidates strongly preferred. Unable to consider those residing outside of of the state of Texas. Additional details will be discussed as part of the interview process.
Why UT Southwestern?
With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued patients and employees. With over 20,000 employees, we are committed to continuing our growth with the best professionals in the healthcare industry. We invite you to be a part of the UT Southwestern team where you’ll discover teamwork, professionalism, and consistent opportunities for growth.
EXPERIENCE | EDUCATION:REQUIRED:
High school diploma or equivalent (Bachelor's degree preferred)
And, 7 years professional revenue cycle working experience, including: 4 years medicine, ancillary, or surgical coding; 1 year clinical and or technical denials management/prevention; and 3 years progressive management in health care administration, physician group practice, and/or claims processing is required.
Manager experience must include producing positive results in a 100% metric driven work environment.
Advanced degree(s) (Bachelors, Masters) may be considered in lieu of experience.
Professional Coding Certification required (e.g., CPC, CCS-P). CPB (preferred).
JOB DUTIES:
Accountable and responsible for the clinical denial prevention and management program for either the centralized Medicine and Ancillary or Surgical revenue cycles in a collections metric driven environment. Monitor appeal effectiveness and denial prevention efforts by reviewing Epic work queues and reports, MS Excel remit code level reports, and the Epic staff note payment percentage report. Monitors Epic follow-up work queue automation rules to ensure they are functioning correctly and or if adjustments or new rules need to be written. Conducts analysis of denials and denial trends by type and payor. Monitors payor reimbursement policies to prevent future claim denials and or internal denial routing for correct and prompt resolution.
Coordinates, with supervisor, the appeals process for all balances deemed appropriate. Facilitates payor denials related communication with revenue cycle operations staff, clinical operations staff, and Revenue Cycle Operations management.
Works with staff to identify the root cause of denials and to implement effective strategies and process improvements, to reduce costly delays in payment. Assures prompt action is taken on denials by coordinating with supervisor/staff to create written and/or verbal clinical appeals with payers.
Formulates letters of appeal. Ensuring they include relevant and effective clinical documentation from the medical record; supported by current industry clinical guidelines, evidence-based medicine, local and national medical management standards, and clinical protocols.
Actively participates in the University Edit Administration Committee to ensure accountability for denials reduction performance and ensures compliance with all governmental regulations and non-governmental guidelines.
Maintains and applies an excellent understanding of physician reimbursement policy and coding methodologies including, but not limited to AMA, CMS, and specialty societies to ensure physician practice revenue integrity and compliant documentation and coding.
Performs other duties as assigned.
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.