Technical Denials Management Specialist III at UT Southwestern Medical Center

Dallas, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

07 Jan, 26

Salary

0.0

Posted On

09 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Management, Insurance Verification, Appeals Preparation, Customer Service, Medical Billing, Accounts Receivables, Payment Trends, Denial Resolution, Contract Interpretation, Data Entry, Communication Skills, Analytical Skills, Problem Resolution, Regulatory Knowledge, Team Collaboration, Training Assistance

Industry

Higher Education

Description

THE UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER JOB SUMMARY UT Southwestern Medical Center has an opening within the Revenue Cycle Department team for a Technical Denials Management Specialist III. The successful candidate’s experience should include but is not limited to the following skills: Capable of reviewing Explanation of Benefits (EOB) from payors to determine how the claims were managed. Contacting insurance carriers to check on the status of claims, appeals, and insurance verification. Review, research and resolve claim denials and appeals for various insurance companies while identifying payment trends in an effort to maximize collections. Knowledgeable with payors including Managed Care, Commercial, Medicare, and Medicaid Preparing/Submitting appeals related to denied services. This is a work from home (WFH) opportunity. The successful applicant must live within the Greater DFW area and be available to come to the office for equipment pickup, office meetings, and training. Additional details regarding WFH will be discussed as part of the interview process. Shift: 8-hour days, Monday through Friday ESSENTIAL FUNCTIONS Job Duties Contact payers, via website, phone and/or correspondence, regarding reimbursement of unpaid accounts over thirty (30) days or more, also researching and following up on denials and request for additional information. Interpret Manage Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection. Make necessary adjustments as required by plan reimbursement. Perform payment validation by utilizing internal and/or external resources to ensure proper reimbursement. Review, research and appeal partially denied claims for reconsideration. Responsible for contacting patients to gain additional information required to resolve outstanding insurance balances. Function as resource person for departmental personnel to answer questions and assist with problem resolution. Review and resolve provider NPI/TPI claim edits rejections. Review and resolve provider NPI/TPI claim denial. Assist with working Claim Edit Work queues. Assist with working Team Lead Work queues. Assist with New Hire Training. Performs other duties as assigned. QUALIFICATIONS Education and Experience Required Education High School Diploma or Associate's Degree Experience 4 years experience in medical claims recovery and/or collections with High School Diploma. or 2 years experience in medical claims recovery and/or collections within a healthcare or insurance environment is preferred with Associates Degree. Knowledge, Skills and Abilities Work requires a self-starter, with ability to work well as part of a team and independently. Work requires ability to communicate effectively with patients, insurance companies, clinical staff and management. Work requires ability to handle large volumes of work. Work requires ability to work in a fast paced, production oriented environment. Work requires excellent customer service skills. Work requires experience in Medical Billing, Accounts Receivables, and/or Collections within a healthcare or insurance environment. Work requires good organizational, flexibility and analytical skills when resolving more complex unpaid claims. Work requires knowledge of billing and/or collections and regulations. Work requires knowledge of CMS 1500, ICD-9, and CPT coding is preferred. Work requires one to exhibit excellent work ethics and commitment to job responsibilities. Work requires one to possess a professional and courteous demeanor while being assertive and confident in their collection efforts. Work requires one to possess quick and accurate alpha/numeric data entry skills. Work requires presence of a positive image that reflects well on the organization. Work requires strong written and verbal communication skills. Work requires understanding of the requirements of Medicaid, Medicare and insurance billing. PHYSICAL DEMANDS/WORKING CONDITIONS Physical Demands Talking Working Conditions Office Setting Salary Salary Negotiable 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 Statement 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.

Responsibilities

The Technical Denials Management Specialist III is responsible for reviewing and resolving claim denials and appeals while maximizing collections. This includes contacting insurance carriers, interpreting contracts, and preparing appeals for denied services.