Claims Edit Specialist II

UT Southwestern Department of Dermatology; Dallas (TX); Hybrid; USD 45,000 - 65,000; Full time

Benefits offered by this job

PPO medical plan

Paid Time Off

Retirement Program

Paid Parental Leave

Tuition Reimbursement

Public Service Loan Forgiveness

Job summary

UT Southwestern Department of Dermatology is seeking a Claims Edit Specialist II in Dallas to review and process insurance claim edits. The role requires accurate processing under supervision, with emphasis on billing system updates and adherence to procedures.

The candidate should have strong experience in medical billing, EOBs, and provider communications. The position is hybrid with responsibilities across multiple billing areas, including eligibility checks and denials/resubmissions, and

Qualifications

• Education: High School Diploma or equivalent.
• Experience: 4 years experience with medical billing or claims processing, knowledge of billing and/or collections rules and regulations.

Responsibilities

• Reviews and processes basic and complex insurance claim edits through the billing system.
• Updates the billing system with eligibility/benefit verification and authorization information.
• Reposts and resubmits claims based on research findings and billing system updates.
• Works in all professional billing service areas.
• Updates registration and demographic information in at least two hospital billing service areas.
• Assists lower level specialists and escalates issues when needed.

Skills

Epic experience

Registration experience

Health insurance knowledge

Understanding EOB

Multitasking

insurer/patient outreach

Education

High School Diploma or equivalent

Tools

Outlook

Excel

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 number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report (Opens in a new window), 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!

Location: Dallas, TX
Location Type: Hybrid
Job Number: 968089
Category: Insurance/Billing
Posting Date: 1 Day Ago
Job Title: Claims Edit Specialist II

Job Summary

The Claims Edit Specialist is responsible for reviewing and processing basic and complex insurance claim edits in a timely manner under direct supervision. This position works under a department supervisor and is expected to complete assigned claims in a timely manner while following established procedures and guidelines.

Key Requirements

• Must reside in the Greater Dallas–Fort Worth (DFW) area.
• Shift: 8‑hour days, flex shift.

Job Expectations

• Work both independently and collaboratively within a team to achieve production goals and deadlines.
• Demonstrate a strong commitment to productivity by staying focused and on task without constant supervision.
• Effectively communicate with colleagues, supervisors, and managers to ensure clarity, alignment, and successful outcomes.
• Take ownership of assigned tasks and projects, demonstrating accountability and reliability in meeting expectations.
• Adapt to changing priorities and work demands while maintaining a high level of quality and efficiency.
• Proactively identify opportunities for process improvement and contribute innovative solutions to enhance overall productivity and teamwork.

Hard Skills

• Epic experience
• Knowledge and experience with registration
• Knowledge and experience with health insurance carriers
• Ability to read and understand Explanation of Benefits
• Ability to multitask.
• Contacting insurance companies and patients

Soft Skills

• Outlook experience
• Team experience
• Excel experience
• Medical Terminology

Benefits

• 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

Required Experience and Education

• Education: High School Diploma or equivalent
• Experience: 4 years experience with medical billing or claims processing, knowledge of billing and/or collections rules and regulations. May consider education in lieu of experience.

Job Duties

• Reviews and processes basic and complex insurance claim edits through the billing system.
• Utilizes vendor and third‑party websites for eligibility/benefit verification and authorization information. Updates the billing system accordingly.
• Reposts and resubmits claims based on research findings and billing system updates.

Works in all professional billing service areas.

Updates registration and demographic information in at least two hospital billing service areas.

Assists lower level specialists. May escalates issues above knowledge base to higher level specialist or supervisor.

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 duties as assigned.

Security and EEO Statement

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.