UT Southwestern Medical Center
Clinical Denial Management Specialist III
UT Southwestern Medical Center, Dallas, Texas, United States, 75215
Clinical Denial Management Specialist III
Join to apply for the
Clinical Denial Management Specialist III
role at
UT Southwestern Medical Center .
Be among the first 25 applicants.
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 employees. Ranked as the number 1 hospital in Dallas‑Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on‑site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you'll discover a culture of teamwork, professionalism, and a rewarding career!
Job Summary The Revenue Cycle Department team has a new opportunity available for the role of
Clinical Denial Management Specialist I
(Note: the position title is Clinical Denial Management Specialist III in the posting). Works under moderate supervision to perform intermediate‑level billing/denial responsibilities. The expectations for this position shall include but not be limited to the following:
Three (3) years of follow‑up / collections experience
Review, research, and resolve denial of professional claims related to CPT codes, place of service, modifiers, and payer policies.
Reconcile expected payment and make necessary adjustments as required by plan reimbursement. Review and interpret documentation.
Prepare and submit appeals to payers based on payor guidelines.
Contact payers regarding reimbursement of denied claims.
Review accuracy of payment to account.
Resolve discrepancy between insurance and billing.
Provide feedback on denial trends to leadership.
Applicants must be able to work within a 100% metric centric environment.
Shift: Flex shift, start time between 0600‑0900.
Work from home (WFH): This is a work from home position. Applicants must live in the state of Texas. Additional details shall be discussed as part of the interview process.
Benefits
PPO medical plan, available day one at no cost for full‑time employee‑only coverage
100% 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!
Experience and Education Required Qualifications
Education: High School Diploma or equivalent.
Experience: 3 years medical billing or collections experience. Must demonstrate the ability to work clinical denials for complex E&M services, diagnostic studies, and/or minor surgical procedures and must demonstrate a strong knowledge of medical claims recovery and/or collections rules and regulations.
Preferred Qualifications
Education: Coding certifications (CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS, CCA) and/or degrees (associate, bachelor, master) are preferred and may be considered in lieu of experience.
Licenses and Certifications: CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS, CCA (certification upon hire).
Job Duties
Review, research and resolve coding denials for complex diagnostic studies, endoscopic, interventional and/or major surgical procedures. 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 complex coding denials. Identify denial, payment, and coding trends in an effort to decrease denials and maximize collections.
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.
Requires knowledge of carrier specific claim appeal guidelines. This includes Claim Logic, internet, and paper/fax processes. Requires proven analytical, and decision making skills to determine what selective clinical information must be submitted to properly appeal the denial. Requires proven knowledge of CPT and ICD‑10 coverage policies, internal revenue cycle coding processes and the billing practices of the specialty service line. This position requires clear and concise written and oral communication with payors, providers, and billing staff to ensure resolution of complex coding denials.
Requires the ability to read and interpret E&M notes, complex diagnostic study results, endoscopic and interventional results and/or major surgical operative notes. Based on the documentation review, confirm or change the billed CPT code(s), diagnosis code(s) and modifiers (if applicable) in order to attain denial resolution. Requires proven knowledge of the specialty specific service line documentation requirements. Must be familiar with the Medicare and Medicaid teaching physician documentation billing rules within 60 days of hire.
Serves as a resource to the FERC Team Leads, Compliance Auditors, Medical Collectors and MSRDP Clinical Denials Management Specialist I & II. Requires a billing and coding knowledge level that provides guidance on and resolution to resolve claim denials and rejections.
Makes necessary adjustments as required by plan reimbursement.
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‑subject 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‑subject research records.
Performs other duties as assigned.
Security and EEO Statement Security This position is security‑sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.
EEO UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.
Location Primary Location: Texas-Dallas-5323 Harry Hines Blvd
Job Details Job Type: Standard
Schedule: Full‑time
Shift: Day Job
Employee Status: Regular
Work Locations: 5323 Harry Hines Blvd
Job Posting Date: Dec 25, 2025, 3:31:55 AM
#J-18808-Ljbffr
Clinical Denial Management Specialist III
role at
UT Southwestern Medical Center .
Be among the first 25 applicants.
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 employees. Ranked as the number 1 hospital in Dallas‑Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on‑site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you'll discover a culture of teamwork, professionalism, and a rewarding career!
Job Summary The Revenue Cycle Department team has a new opportunity available for the role of
Clinical Denial Management Specialist I
(Note: the position title is Clinical Denial Management Specialist III in the posting). Works under moderate supervision to perform intermediate‑level billing/denial responsibilities. The expectations for this position shall include but not be limited to the following:
Three (3) years of follow‑up / collections experience
Review, research, and resolve denial of professional claims related to CPT codes, place of service, modifiers, and payer policies.
Reconcile expected payment and make necessary adjustments as required by plan reimbursement. Review and interpret documentation.
Prepare and submit appeals to payers based on payor guidelines.
Contact payers regarding reimbursement of denied claims.
Review accuracy of payment to account.
Resolve discrepancy between insurance and billing.
Provide feedback on denial trends to leadership.
Applicants must be able to work within a 100% metric centric environment.
Shift: Flex shift, start time between 0600‑0900.
Work from home (WFH): This is a work from home position. Applicants must live in the state of Texas. Additional details shall be discussed as part of the interview process.
Benefits
PPO medical plan, available day one at no cost for full‑time employee‑only coverage
100% 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!
Experience and Education Required Qualifications
Education: High School Diploma or equivalent.
Experience: 3 years medical billing or collections experience. Must demonstrate the ability to work clinical denials for complex E&M services, diagnostic studies, and/or minor surgical procedures and must demonstrate a strong knowledge of medical claims recovery and/or collections rules and regulations.
Preferred Qualifications
Education: Coding certifications (CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS, CCA) and/or degrees (associate, bachelor, master) are preferred and may be considered in lieu of experience.
Licenses and Certifications: CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS, CCA (certification upon hire).
Job Duties
Review, research and resolve coding denials for complex diagnostic studies, endoscopic, interventional and/or major surgical procedures. 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 complex coding denials. Identify denial, payment, and coding trends in an effort to decrease denials and maximize collections.
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.
Requires knowledge of carrier specific claim appeal guidelines. This includes Claim Logic, internet, and paper/fax processes. Requires proven analytical, and decision making skills to determine what selective clinical information must be submitted to properly appeal the denial. Requires proven knowledge of CPT and ICD‑10 coverage policies, internal revenue cycle coding processes and the billing practices of the specialty service line. This position requires clear and concise written and oral communication with payors, providers, and billing staff to ensure resolution of complex coding denials.
Requires the ability to read and interpret E&M notes, complex diagnostic study results, endoscopic and interventional results and/or major surgical operative notes. Based on the documentation review, confirm or change the billed CPT code(s), diagnosis code(s) and modifiers (if applicable) in order to attain denial resolution. Requires proven knowledge of the specialty specific service line documentation requirements. Must be familiar with the Medicare and Medicaid teaching physician documentation billing rules within 60 days of hire.
Serves as a resource to the FERC Team Leads, Compliance Auditors, Medical Collectors and MSRDP Clinical Denials Management Specialist I & II. Requires a billing and coding knowledge level that provides guidance on and resolution to resolve claim denials and rejections.
Makes necessary adjustments as required by plan reimbursement.
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‑subject 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‑subject research records.
Performs other duties as assigned.
Security and EEO Statement Security This position is security‑sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.
EEO UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.
Location Primary Location: Texas-Dallas-5323 Harry Hines Blvd
Job Details Job Type: Standard
Schedule: Full‑time
Shift: Day Job
Employee Status: Regular
Work Locations: 5323 Harry Hines Blvd
Job Posting Date: Dec 25, 2025, 3:31:55 AM
#J-18808-Ljbffr