Reimbursement Specialist, Senior -

JOB SUMMARY

About Cardiovascular & Thoracic:

Cardiovascular and Thoracic Surgery at UT Southwestern Medical Center is one of the nation's leading programs, with more than 600 open-heart procedures and more than 500 thoracic procedures performed each year. Our surgeons are continuously involved in clinical and basic science research and are dedicated to finding new therapies that will safely and effectively improve our patients' quality of life. Educating and training tomorrow's cardiothoracic surgeons to be the best in every regard is one of our top priorities.

The Cardiovascular and Thoracic Surgery Department at the UT Southwestern Medical Center has an opportunity available for a Senior Reimbursement Specialist. This position is a key member of the department's billing team. The duties for this position will include but not be limited to the following:

• Ability to have direct interaction and contact regarding insurance verification/eligibility and pre-certification on complex patient accounts. (Additional research and knowledge are needed to obtain this information)
• Requires detailed knowledge of medical insurance benefits.
• Access to UTSWs resources regarding managed care contracts.
• Extreme attention to accuracy, strong service, and compassion for our valued patients, and the ability to assist them in sometimes stressful situations.
• Excellent multi-disciplinary teamwork skills are required.
• Ability to coordinate with physician and/or clinical team regarding additional information needed to obtain pre-certification and insurance benefits as well as when an "out of network" situation becomes apparent, or other potential payor technicalities arise.

Other duties:

• Assign CPT, ICD, and modifiers.
• Ensure services are worked to meet three (3) to six (6) days.
• Highly motivated.
• Excellent communication skills.
• Ability to communicate with the team and providers.

Preferred soft skills include:

• Microsoft Outlook
• EPIC •
• Excellent time management skills • . •
• Excellent communication both orally and in writing •
• Proven ability to communicate, assign and/or interpret CPT, ICD, and modifiers with physicians and/or clinical team.

Shift: 8am-5pm (Monday thru Friday) including 1-hour lunch break

WFH is possible, depending on experience (DOE). Additional details related to this shall be discussed as part of the interview process.

EXPERIENCE | EDUCATION:

REQUIRED:

• High School diploma or GED and six (6) years progressively responsible experience in medical insurance, medical billing, or medical reimbursement.
• Certified Professional Coder (CPC), Advanced Records Technician (ART), or Registered Records Administrator (RRA) preferred.

JOB DUTIES:

• Performs complex policy analysis for managed care issues by reviewing contracts, writing clause revisions, making recommendations for reimbursement policy changes, reviewing reports and financial data, and analyzing fee schedules, encounter forms, diagnosis, and procedure codes; ensures contracts reflect appropriate business decisions.
• Ensures projects related to reimbursement issues are completed on time and changes are implemented appropriately.
• Conducts meetings, organizes activities, reviews data analyses and reports, and creates reimbursement policies and procedures.
• Documents findings of inquiry and opinion letters.
• Maintains contract files, and files for research documents.
• Provides supervision to staff of lower grade in reimbursement operations.
• Performs other duties as assigned.

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. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; sex; including sexual harassment; age; disability; genetic information; citizenship status; and protected veteran status. In addition, it is UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.