INSURANCE CLAIMS TEAM LEAD (UTRGV EMPLOYEES ONLY)

The University of Texas Rio Grande Valley Job Site; Harlingen (TX); On-site; USD 64,000 - 90,000; Full time

Job summary

The University of Texas Rio Grande Valley is seeking a Revenue Cycle Supervisor to oversee third-party payer claim functions, focusing on follow-up, denials, and collections. The role ensures regulatory compliance and optimizes reimbursement for services rendered.

Responsibilities include coaching staff, monitoring denials, using Power BI to track performance, and collaborating with coders and clinic teams.

Qualifications

• Four (4) years of medical, hospital, or healthcare revenue cycle related experience, including thorough knowledge of registration, scheduling, pre-certification, prior authorization, coding, claims billing and insurance follow-up, payer reimbursement, posting, and collections processes.
• Excellent verbal and written communication skills; ability to educate/train others and foster a cooperative work environment.
• Knowledge of CPT4, ICD10, HCPCS codes and modifiers; proficient with Microsoft Office applications.
• Associate degree in healthcare-related field or equivalent experience in lieu of degree.

Responsibilities

• Oversees and coordinates the day-to-day operations of all third-party payers claims functions, including follow-up, denials, and rejections.
• Ensures adherence to third party payer regulatory guidelines, department policies, and procedures.
• Monitors denial management to ensure corrective actions by billing staff to obtain full reimbursement.
• Works with billing specialists to ensure proper follow-up, collections, and appeals in compliance with policies.
• Provides coaching and training to new hires and existing staff.
• Monitors workflow and directs tasks to manage fluctuating volumes.
• Reviews Power BI dashboards to ensure AR follow-up, denials, and adjustments meet productivity and quality goals.
• Communicates regulatory changes to management and denial teams promptly.
• Reviews and identifies denial trends to minimize financial losses and improve processes.
• Oversees write-offs for adjustments and prepares manual adjustments as needed.
• Evaluates accounts to ensure all third-party reimbursement options have been exhausted.
• Prepares reports on key quality and productivity indicators for upper management.

Skills

Communication skills

Analytical skills

CPT4/ICD10/HCPCS knowledge

Microsoft Office

Education

Associate Degree in Healthcare related field

Tools

Excel

Word

PowerPoint

Job description

Office Location
The University of Texas Rio Grande Valley
1201 W. University Drive
Human Resources
MASS Building 2 nd Floor
Edinburg, TX 78539

Edinburg: [phone]
Brownsville: [phone]
Office hours:
Monday-Friday
8:00a.m. - 5:00p.m.

Faculty Recruitment:
College of Engineering & Computer Science: [e-mail]

Robert C. Vackar College of Business & Entrepreneurship: [e-mail]

Please see Special Instructions for more details.

Dear Applicant, Human Resources will not be held responsible for redacting any confidential information from the documents you attach with your application. The confidential information includes the following: *Date of Birth *Social Security Number *Gender *Ethnicity/Race Please make sure that you omit this information prior to submission. We are advising that Human Resources will be forwarding your application to the department as per your submission. If you have any questions, please do not hesitate to contact us at [phone] and/or [e-mail].

Position Information

Posting Number

Posting Number SRGV7151

Working Title

Number of Vacancies

Number of Vacancies 1

Location

Department

Department School of Medicine / Clinical Affairs

FTE

FTE 1.0

FLSA

FLSA Non-Exempt

Scope of Job

Oversees and coordinates the day-to-day operations of all third-party payers claims functions to include insurance follow-up and collection processes, denials, and rejections.

Description of Duties

• Supervises and coordinates the day-to-day activity for third-party payer claim functions to include follow-up processes, denials, and rejections (bill holds) activities to ensure UTRGV Health receives appropriate payments for services rendered.
• Ensures adherence to third party payer regulatory and legal guidelines, department policies and procedures.
• Monitors the denial management process to ensure that appropriate corrective actions are taken by billing specialists to obtain all reimbursement due to UT Health RGV .
• Works closely with billing specialists to ensure proper insurance follow-up, collections, and appeals are in compliance with UT Health RGV policies and procedures.
• Provides coaching and training to new hires and existing staff for the assigned area.
• Monitors rejections/denials (bill holds) workflow and directs work tasks as necessary to manage fluctuation volumes.
• Reviews and monitors Power BI dashboards to ensure account receivables follow-up/collections, denials (bill holds), and adjustments activities are meeting established productivity, quality, and reimbursement goals.
• Communicates regulatory changes to management and denials/insurance follow-up team promptly and effectively.
• Reviews, analyzes, and identifies denial trends to minimize financial losses and maximize opportunities to improve processes.
• Oversees approves and reconciles write-offs for adjustments as per policy and prepares manual adjustments as needed.
• Evaluates accounts to ensure that all third-party reimbursement options have been exhausted in resolving outstanding account balances.
• Reports on key quality, service, and coding productivity indicators on a regular basis to upper management.
• Maintains good communication with coders, providers, patient access team, and clinic team to ensure an effective working relationship.
• Works with leadership to develop and implement insurance follow-up and denial policies and procedures per Federal, State, and payer regulations and guidelines.
• Participates in hiring and evaluation of assigned staff.
• Stays abreast of current changes in billing, coding, and reimbursement requirements for government programs and other third-party payers.
• Performs other duties as assigned.

Supervision Received

General supervision from assigned supervisor.

Supervision Given

Direct supervision of assigned staff.

Required Education

• Associate Degree in Healthcare related field, or
• Two (2) years of the required experience in lieu of associate degree in addition to the required experience.

Preferred Education

N/A

Licenses/Certifications

N/A

Required Experience

Four (4) years of medical, hospital, or healthcare revenue cycle related experience, including thorough knowledge of registration, scheduling, pre-certification, prior authorization, coding, claims billing and insurance follow-up, payer reimbursement, posting, and collections processes.

Preferred Experience

Previous supervisory and coding experience. Bilingual (English/Spanish).

Equipment

Use of standard office equipment. Proficient use of computers and working knowledge of Microsoft Office – Excel, Word, PowerPoint

Working Conditions

Needs to be able to successfully perform all required duties. Office/clinic environment; some travel and weekend work are required. Exerting up to 20 pounds of force frequently, and/or a negligible amount of force constantly to move objects. Must be familiar with CPT4, ICD10, HCPCs codes and use of modifiers. Ability to be flexible with assignments and multi-task as needed. Ability to demonstrate problem-solving skills in dealing with billing and collections-related issues. UTRGV is a distributed institution, which requires presence at multiple locations throughout the Rio Grande Valley.

Other

Excellent verbal and written communication skills. Ability to educate/train others as needed and foster a cooperative work environment. Excellent time management skills. Ability to communicate effectively. Must demonstrate good problem-solving skills. Attention to detail and strong analytical skills. Knowledge of medical terminology and coding. Knowledge of patient billing claims process. Familiarity with insurance explanations of benefits and denial codes. Demonstrated organizational skills and the ability to prioritize and manage tasks based on established criteria.

Physical Capabilities

N/A

Employment Category

Employment Category Full-Time

Minimum Salary

Minimum Salary Commensurate with Experience

Posted Salary

Posted Salary Commensurate with Experience

Position Available Date

Position Available Date 11/20/2023

Grant Funded Position

Grant Funded Position No

EEO Statement

It is the policy of The University of Texas Rio Grande Valley to promote and ensure equal employment opportunities for all individuals without regard to race, color, national origin, sex, age, religion, disability, sexual orientation, gender identity or expression, genetic information or protected veteran status. In accordance with the requirements of Title VII of the Civil Rights Act of 1964, the Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, and the Americans with Disabilities Act of 1990, as amended, our University is committed to comply with all government requirements and ensures non-discrimination in its education programs and activities, including employment. We encourage women, minorities and differently abled persons to apply for employment positions of interest.

Special Instructions to Applicants

Dear Applicant, Human Resources will not be held responsible for redacting any confidential information from the documents you attach with your application. The confidential information includes the following: *Date of Birth *Social Security Number *Gender *Ethnicity/Race Please make sure that you omit this information prior to submission. We are advising that Human Resources will be forwarding your application to the department as per your submission. If you have any questions, please do not hesitate to contact us at [phone] and/or [e-mail].

Additional Information

UTRGV is a distributed location institution and working location is subject to change based on need.
All UTRGV employees are required to have a criminal background check ( CBC ). Incomplete applications will not be considered.
Substitutions to the above requirements must have prior approval from the VP of HR & Talent Development .

Required fields are indicated with an asterisk (*).

• * Are you now, or previously, employed by The University of Texas System or any of its institutions?
  • Yes - I currently am employed by the UT System or its institutions
  • Yes - I have previously been employed by the UT System or its institutions
  • No - I have never been employed by the UT System or its institutions
• Yes
• No
• * Please select your highest level of completed education.
  • 6th grade education
  • 10th grade education
  • High School Diploma or GED
  • Associates Degree, Technical, or Trade School Degree/Certification or 60 Hours of College Hours
  • Bachelors Degree from an accredited university
  • Masters Degree from an accredited university
  • Ph. D. or other terminal degree from an accredited university
  • None of the above
• * Please provide the field of study for your education: (Open Ended Question)
• * Please indicate the number of years of work experience you have directly related to the position in which you are applying for:
  • Less than 1 year
  • 1 year
  • 2 years
  • 3 years
  • 4 years
  • 5 years
  • 6 years
  • 7 years
  • 8 years
  • 9 years
  • 10 years
  • Over 10 years
• * Do you meet the minimum requirements for this position?
  • Yes
  • No