Technical Denials Management Specialist II - Revenue Cycle

JOB SUMMARY:

UT Southwestern Medical Center has an opening within the Revenue Cycle Department team for a Technical Denials Management Specialist II. The ideal applicants' day will include but not be limited to the following:

• Knowledgeable with payors including Managed Care, Commercial, Medicare, and Medicaid
• Prepare appeals related to denied services
• Capable of reviewing explanation of benefits (EOB) from payors to determine how the claims was handled
• Contact insurance carriers to check on the status of claims, appeals, mailing, registration, and insurance verification
• Other duties as assigned

This is a work from home (WFH) opportunity, however, the successful applicant must live within the state of Texas and also be available to come to the office for equipment pickup exchange, office meetings, and training, etc. Specific details in regard to WFH shall be discussed as part of the interview process.

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; Associate's degree preferred
• Two(2)years experience in medical claims recovery and/or collections required

JOB DUTIES:

• Contacting 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 requests for additional information.
• Interpret Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection.
• Make necessary adjustments as required by plan reimbursement.
• Performs payment validation by utilizing internal and/or external resources to ensure proper reimbursement.
• Reviews, research and appeal partially denied claims for reconsideration.
• Responsible for contacting patients to gain additional information required to resolve an outstanding insurance balance.
• Functions as resource person for departmental personnel to answer questions and assists with problem resolution.
• 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. 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.