Account Adjuster II

UTSW; Texas; Hybrid; USD 42,000 - 64,000; Full time

Job summary

UT Southwestern Medical Center seeks a skilled professional to research and resolve credit balance accounts, posting corrections and processing refunds. Responsibilities include communications with insurers, patients, and internal departments to ensure timely resolutions while maintaining accurate documentation.

Applicants should have strong follow-up/collections experience, a high school diploma, and a background in managed care contracts.

Qualifications

• High School Diploma or equivalent.
• 3 years’ experience performing follow-up/collections, payment posting, appeals and managed care contract understanding/interpretation.
• Preferred: six months related work experience performing appeals and managed care contract understanding/interpretation.

Responsibilities

• Reviews patient accounts for incorrect posting and may contact insurance companies or patients to research posting errors.
• Validate and issue refunds to patients and third-party carriers for overpayment or duplicate payments.
• Identifies and resolves credits posted to patient accounts and distributes funds per policy.
• Identifies and denies any refund request letters past the insurance refund deadline.
• Transfers payments between invoices/accounts as needed.
• Communicates refund requests to payers/third parties via phone and written correspondence.
• Verifies insurance accuracy, updates demographics, rebills claims and performs appeals if applicable.
• Duties may involve direct patient interaction and handling of patient/subject records.

Education

High School Diploma or equivalent

Job description

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 employees. Ranked as the No. 1 hospital in Dallas-Fort Worth according to U.S. News & World Report , we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you’ll discover a culture of teamwork, professionalism, and a rewarding career!

JOB SUMMARY

• Researches and resolves credit balance accounts resulting from errors in payment posting, charge entry, contractual adjustments, and overpayments.
• Resolves all applicable problems with patient accounts, including issuing refunds.
• Resolves all insurance companies refund request letters received.
• Reviews patient account transactions and payment history to identify discrepancies, determine the root cause of credit balances, and ensure appropriate account resolution.
• Researches and validates refund amounts, processes account adjustments, and follows established procedures for issuing patient and insurance refunds.
• Communicates with insurance companies and internal departments to resolve outstanding account issues and refund requests.
• Maintains accurate documentation of account research, adjustments, and refund activity while monitoring outstanding credit balances to ensure timely and accurate resolution.
• This is a Work from home (WFH) positions. Applicants must live within 1 hour or less of the Greater DFW area.
• Shift – Flex shift starts between 0600-0900, 8-hour days Monday through Friday.

BENEFITS

UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100% coverage for preventive healthcare-no copay
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer
• Learn more about these and other UTSW employee benefits!

EXPERIENCE AND EDUCATION

Required

• Education

High School Diploma or equivalent

• Experience

3 years’ experience performing follow-up/collections, payment posting, appeals and managed care contract understanding/interpretation

Preferred

• Experience

At least six (6) months related work experience performing appeals and managed care contract understanding/interpretation

JOB DUTIES

• Reviews patient accounts for incorrect posting which may include contacting insurance companies, patients and researching insurance payments to identify and correct posting errors; reviewing credit reports and age reports to identify posting problems.
• Validate and issue refunds to patients and third-party carriers for overpayment or duplicate payment, according to state regulations and contractual obligations.
• Identifies and resolves credits posted to patient accounts; corrects overpayments or distributing funds according to UT Southwestern policy.
• Identifies and denies any refund request letters that are past the insurance refund deadline.
• Appropriately transfer payments between invoices and/or accounts.
• Communicate, approve, and reject refund requests to payers and third-party carriers, via phone call and written correspondence.
• Verifies insurance is correct, update insurance demographics, rebill claims and perform appeals if applicable.
• 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.
• Performs other related duties as required.

Salary Information

Salary is commensurate with education, skills, and relevant experience.

SECURITY AND EEO STATEMENT

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

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.