JOB SUMMARY:

UT Southwestern Medical Center has a new opportunity for a Eligibility Denial Specialist II MSP in the Revenue Cycle Department team. The ideal applicants' duties and responsibilities will include but not limited to the following:

• Verify insurance
• EPIC experience with understanding of eligibility
• Update registration
• Visit filing order to resolve payor denials

Shift: Flex shift, 8-hour days

Work From Home (WFH): This is a WFH position. Applicants must live within the state of Texas. Additional details shall be provided as part of the interview process.

Quick tip(s):

• Please review the section entitled experience/education and focus on the job requirements.
• Make sure you include the experience listed under the requirements section on your application.

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 patients and employees. With over 20,000 employees, we are committed to continuing our growth with the best professionals in the healthcare industry. We invite you to be a part of the UT Southwestern team where you'll discover teamwork, professionalism, and consistent opportunities for growth.

EXPERIENCE | EDUCATION:

REQUIRED:

• High school diploma or equivalent.
• And four (4) years medical billing, claims processing, and/or insurance eligibility experience.
• May consider medical billing certifications or graduate degrees in lieu of experience.

JOB DUTIES:

This job is responsible for researching any denied claim based on eligibility to ensure correct payers are billed timely on submitted insurance claims.

• Review, research, and resolve denied insurance claims based on eligibility through the billing system, including Medicaid, Medicare, Worker's Compensation, Mental Health payers and third-party payers.
• Interpret Explanation of Benefits from insurance companies on denied claims.
• Contact payers via website, phone and/or correspondence regarding claims denied for eligibility.
• Contact patients and assist with Coordination of Benefits or other coverage denials.
• Works in all professional billing service areas.
• Updates registration and demographic information in all hospital billing service areas.
• Resolves eligibility denials in all clearinghouse and payer rejection WQ's.
• Review and resolve any visit Filing order changes and work advanced Visit Filing Order WQ's.
• Function as a liaison between clinical departments and third-party payers.
• Completes special projects as requested.
• Identifies problems and inconsistencies by using management reports; summarizes findings and makes recommendations to resolve billing issues in an effort to maximize collections.
• 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-subjects 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-subjects research records.

KNOWLEDGE, SKILLS & ABILITIES:

• Work requires the ability to work in a fast paced, production-oriented environment.
• Work requires the ability to analyze problems, develop solutions and implement new procedures.
• Work requires knowledge of insurance billing and various types of health insurance.
• Work requires strong organizational skills.
• Work requires strong oral and written communication skills, including the use of medical terminology.
• Work requires basic working knowledge of spreadsheet and word processing software.

WORKING CONDITIONS:

Work is performed primarily in office area.

SECURITY:

This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

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.