RCM Specialty Follow Up Specialist - Worker's Comp

We’ve learned that what is best for patients is also best for employees. Learn more about why we are one of the Best Companies to Work for in Texas®.

______________________________________________________________________
**Join UMC Physicians: Where Employee Satisfaction Soars at 98%!**

Summary
Title: RCM Specialty Follow Up Specialist – Workers Comp
Department: Central Business Office
Location: Security Park – B27

The RCM Specialty Follow Up Specialist for Workers Comp ensures accurate and timely submission of insurance claims, obtaining missing information, researching denials and documentation, following up on claims, and maintaining compliance with department standards, HIPAA, and governing agency policies and procedures. This position is also responsible for taking action required to resolve rejected, underpaid and denied claims by submitting corrected claims and appeals on a timely basis upon review of unpaid encounters. Works closely with the CBO, practice managers, billers, and coders.

Availability Requirements:
• Ability to work 40 hours per week
• Day Shifts between the hours of 7:30 – 5:30
• 8-hour shifts Monday-Friday
• 9-hour shifts Monday – Thursday | 4-hour shift Friday

Our Mission: To improve the quality of life for our community by providing the best patient experience for every patient.

Our Vision: To be the best place to work and the best place to receive healthcare.

Benefits: UMC Physicians offers a comprehensive benefits package to eligible full-time employees. Benefits include: 
• Paid Time Off  
• Sick Pay 
• Medical, Dental and Vision Insurance
• Employer Paid Group Life and Voluntary Life Insurance  
• Short Term Disability Insurance
• Long Term Disability (after 2 years of employment) 
• Critical Illness, Accident and Cancer Insurance
• Health Care and Dependent Care Spending Accounts
• 401K Retirement Plan with Company Match
• Employee Assistance Program
Note: Some benefits require an employee contribution to participate.

Essential Functions: 
• Review, research and resolve coding denials for complex diagnostic studies,
endoscopic, interventional and/or major surgical procedures. (This includes
denials related to the billed CPT, diagnosis, and modifier.)
• Denial types could include bundling, concurrent care, frequency, limited
coverage and authorization.
• Prepare and submit claims appeals, based on payor guidelines.
• Identify denial, payment, and coding trends in an effort to decrease denials,
improve denial prevention, and maximize collections.
• Contact payers via website, phone and/or correspondence, regarding
reimbursement of claims denied.
• Interpret medical policies and/or Medicare, Medicaid Federal/Government rules
and regulations to ensure proper reimbursement/collection.

Additional Responsibilities: 
Additional duties as assigned.

Knowledge/Skills/Abilities:
• Requires knowledge of carrier specific claims appeal guidelines. (This includes
claim logic, internet, and paper/fax processes.)
• Requires 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 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.
• Determine appropriate action for denial resolution based on documentation.

Minimum Qualifications:
• High School diploma or equivalent
• Two (2) years medical billing or collections required (combination of higher
education and experience may be considered to satisfy years of experience
requirement.)
• Medical terminology
• Type 40wpm, 10 key by touch.
• Strong analytical and critical thinking.

Preferred qualifications:
• Knowledge of Medicare, Medicaid, Commercial, Federal/Government Insurance
procedures.
• Knowledge of denial management, billing/coding guidelines
• Experience in Cardiothoracic, Gastrointestinal, Neurology, OB, Anesthesiology,
and/or Allergy Specialties.
• Previous Workers’ Compensation is preferred.

Environmental Conditions: 
Works in well-lit, heated and ventilated building. Exposure to blood borne pathogens are of low risk. Hours of duty may be irregular.

Physical Requirements: 
• Requ