Job Description

Extended Job Title
Medical Denial Specialist - Orthopaedics

Org Level 1
Texas Tech Univ Health Sciences Ctr

Org Level 7
512701 - Ortho Surgery Dept Lbk Genl

Position Description

Performs work related to clinical denial management. The position is responsible for managing medical denials and conducting a comprehensive review of billing, coding and documentation. The position is responsible for submitting compelling appeals to payors in a timely manner.

Requisition ID

Travel Required

Major/Essential Functions
  • Reviews and manages third party payer reimbursement denials based on the following: documentation, billing accuracy, medical necessity, coding, modifier and related issues. 
  • Identifies and works to resolve charge problems to ensure accurate and complete billing 
  • Educates staff and providers on proper billing, follow-up and documentation practices 
  • Actively manages, maintains and communicates denial/appeal activity to appropriate stakeholders and reports suspected or emerging trends related to payer denials to management with sufficient information for additional follow-up and/or root cause resolutions
  • Completes compelling arguments based on clinical documentation and the medical policies of the payer to use in appeals 
  • Initiates appeals in a timely manner 
  • Submits detailed appeals to payers based on review in accordance with payer and institutional guidelines
  • Makes recommendations for additions/revisions/deletions to claim edits to improve efficiency and reduce denials. 
  • Reviews payer communications, identifies risk for lost reimbursement relation to medical policies and prior authorization requirements. 
  • Submits retro-authorizations in accordance with payer requirements 
  • Engages with coding experts and providers for medical necessity and coding related appeals
  • Engages with Business Office and maintain comprehensive understanding of their policies and procedures for denial and appeal management 
  • Follows write-off procedures for claims unable to be paid

Grant Funded?

Minimum Hire Rate

Pay Basis

Work Location

HSC - Lubbock

Ortho Surgery Dept Lbk Genl

Required Attachments
Cover Letter, Resume / CV

Job Type
Full Time

Pay Statement
Compensation is commensurate upon the qualifications of the individual selected and budgetary guidelines of the hiring department, as well as, the institutional pay plan. For additional information, please reference the institutional pay plan on the Human Resources webpage.

Job Group
Information and Records Clerks


EEO Statement
As an EEO/AA employer, the Texas Tech University System and its components will not discriminate in our employment practices based on an applicant’s race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, genetic information or status as a protected veteran.

Required Qualifications

High school diploma or general education degree (GED); 3 years’ medical office experience with familiarity of current medical billing regulations for major insurance carriers. Certified Professional Coder (CPC), preferred.

Does this position work in a research laboratory?

Application Instructions

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