BILLING SPECIALIST II
Number of Vacancies:
Rio Grande Valley
School of Medicine / Clinical Affairs
Scope of Job:
Reviews, determines accuracy of and applies the correct coding
conventions to patient charge encounters, procedural and surgical
services, as defined through physician documentation, regulatory
agencies, and various third-party payers for oncology services. To
assist with the facilitation of the revenue cycle process following
patient accounts through entire process from coding/charge entry to
completion of payment process working within UT Health RGV
EMR/Practice Management application and with contracted billing
Description of Duties:
• Identifies and enters correct code selection from physician
documentation, to include, but not be limited to: chart notes,
abstracting from medical records documentation, medical diagnostic
and/or interventional reports, ensuring compliant coding selections
• Enters most appropriate Reason for Visit, First Listed Primary
Diagnosis, Procedure(s), Modifiers, and all Secondary Diagnosis
accurately supports medical necessity and CCI edits.
• Verifies that the final diagnosis reflects the care and treatment
rendered to the corresponding code entered.
• Works closely with Revenue Cycle team, clinics, physicians,
departments, and contracted billing agency to resolve issues with
insurance companies regarding incorrect registration information,
claims processing, coding issues, and AR payments or denials.
• Responsible for accurate and timely processing/resolution of
coding edits impacting submission of professional claims as well as
payer rejections and/or denials.
• Identifies when a physician query is appropriate for further
clarification. Recognizes when the documentation is missing or
incomplete and routes appropriately. Validates Fee Schedule driven
CPT code assignment and routes appropriately. Completes review and
final coding when query and/or documentation is available.
• Ensure that patients are charged for all procedures. Reconciles
charges against patient schedules.
• Verifies that coding guidelines are followed and ensures all
elements of Evaluation & Management (E&M) level meet the
Medicare guidelines for E&M level assignment.
• Informs providers of new coding conventions, changes in current
coding conventions, and provides feedback on the providers’ coding
• Maintains working day-to-day knowledge of electronic health
record (EHR) and Practice Management (PM) system.
• Assists in evaluating the medical record for documentation
consistency, adequacy, and signature requirements.
• Maintains Coding Quality Standards and Productivity Standard set
by UT Health RGV.
• Identifies and documents new payer denial trends and notifies
supervisor for escalated follow-up.
• Performs root cause analysis and identifies edit trends timely to
minimize lag delays and maximize opportunities to improve
• Communicates regularly and effectively with physicians, clinic
staff, and revenue cycle staff for accurate and timely resolution
of coding-related claim edits and appeals.
• Provides customer service to patients by addressing their
questions, concerns or complaints.
• Responsible for posting payments and adjustments on patient
accounts. Reconciles payment/adjustment batches daily.
• Runs billing, Accounts Receivable, denials, and any other Revenue
Cycle reports as requested or needed.
• May assist clinics on completing their daily deposits information
and ensure their deposit batches are reconciled daily.
• Assists in month end procedures and reporting.
• May assist in registering patient accounts where interfaces are
not in place with UT Health partners. This includes entering
demographic and insurance information, verifying insurance,
entering referral information and/or prior authorization, posting
charges and/or payments for clinic visits and/or hospital
• May assist clinics on figuring out patient responsibility based
on Fee Schedule and/or assisting them in finding the correct CPT
code to determine patient responsibility.
• Performs other duties as assigned.
General supervision from assigned supervisor.
Direct supervision of assigned staff.
• Associate Degree in Healthcare related field or Registered Health
Information Technician certified, or• Two (2) years of the required
experience in lieu of associate degree in addition to the required
Certified Professional Coder (CPC) or Certified Coding
Specialist-Physician based (CCP-P) from American Health Information
Management Association (AHIMA) or American Academy Professional
Three (3) years of medical coding experience, knowledge of the
entire claims billing, collections, and reimbursement processes
experience in a multi-specialty practice, healthcare facility or
Use of standard office equipment. Proficient use of computers and a
working knowledge of Microsoft Office.
Needs to be able to successfully perform all required duties.
Office Environment; some travel and weekend work is required.
Excellent verbal and written communication skills are required.
Must be very familiar with CPT4, ICD10, HCPCs codes and use of
modifiers. Ability to be flexible with assignments and multi-task
as needed. Ability to demonstrate problem-solving skills in dealing
with billing and collections related issues.
Commensurate with Experience
Commensurate with Experience
Position Available Date:
Grant Funded Position:
If Yes, Provide Grant Expiration Date:
It is the policy of The University of Texas Rio Grande Valley to
promote and ensure equal employment opportunities for all
individuals without regard to race, color, national origin, sex,
age, religion, disability, sexual orientation, gender identity or
expression, genetic information or protected veteran status. In
accordance with the requirements of Title VII of the Civil Rights
Act of 1964, the Title IX of the Education Amendments of 1972,
Section 504 of the Rehabilitation Act of 1973, and the Americans
with Disabilities Act of 1990, as amended, our University is
committed to comply with all government requirements and ensures
non-discrimination in its education programs and activities,
including employment. We encourage women, minorities and
differently abled persons to apply for employment positions of
Special Instructions to Applicants:
Dear Applicant, Human Resources will not be held responsible for
redacting any confidential information from the documents you
attach with your application. The confidential information includes
the following: *Date of Birth *Social Security Number *Gender
*Ethnicity/Race Please make sure that you omit this information
prior to submission. We are advising that Human Resources will be
forwarding your application to the department as per your
submission. If you have any questions, please visit our Careers
site at https://careers.utrgv.edu
detailed contact information.
UTRGV is a distributed location institution and working location is
subject to change based on need.
All UTRGV employees are required to have a criminal background
check (CBC). Incomplete applications will not be considered.
Substitutions to the above requirements must have prior approval
from the VP of HR & Talent Development .
To apply, visit https://careers.utrgv.edu/postings/40587