PFS REP II

University of Texas Southwestern Medical Center; Dallas (TX); On-site; USD 55,000 - 80,000; Full time

Job summary

UT Southwestern Medical Center in Dallas, TX seeks an experienced medical billing specialist to analyze payer underpayments, denials, and variances, and to file professional appeals as needed. You will manage outbound inquiries to payers and coordinate with internal departments to ensure proper invoicing and adjudication of claims.

The role requires 5 years of hospital billing experience, with strong knowledge of payer portals and reimbursement rules.

Qualifications

• Experience in hospital or medical billing
• Ability to analyze payer underpayments, variances and denials
• Effective communication with payers and internal teams
• Knowledge of reimbursement rules for third-party payers

Responsibilities

• Analyze payer underpayments, variances and denials and file appeals as needed.
• Make outbound calls or inquiries to verify claim status with payers.
• Coordinate with departments to ensure accurate invoicing and adjudication.
• Assist with special projects and improvement initiatives in billing/collections.
• Respond to payer inquiries timely and accurately to ensure payment.
• Attend trainings and meetings related to revenue cycle operations.

Skills

Medical billing

Denials management

Payer communications

Accounts receivable

Education

High School Diploma

Bachelor's degree

Tools

Billing software

Payer portals

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 youll discover a culture of teamwork, professionalism, and a rewarding career!

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
• 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 and
• Experience 5 years hospital or medical billing experience.

Preferred

• Education Bachelor's Degree
• Hospital billing and collections experience
• Traditional Medicare billing and follow-up experience

JOB DUTIES

• Analyze payer underpayments, variances, and denials. Escalate trends, make comprehensive suggestions, and file professional appeals according to our contractual agreements and UT Southwestern policy. This includes timely processing of allocated volume of accounts, based on established production guidelines and time parameters provided for workflow.
• Responsible for outbound calls and/or status inquiries via payer's website validating receipt of medical claims and adjudication status within established timeframes. Display competent ability to access, navigate, and manage account information through phone calls and payer websites. Documents all work and calls performed, in accordance to policy. This includes complete contact information, good grammar, and expected outcomes.
• Display competency and ability to work within client based, research, and UTSW special arrangements. This includes, but is not limited to: calculating the physician and hospital share and working with MSP to transfer the physician's share to that department, working with other departments at UTSW to properly invoice clients and bill claims for proper adjudication per our agreements.
• Be knowledgeable on all payer types and effectively work on special projects for specific initiatives for account resolution projects. Demonstrate confidence and sound decision making for processing through large volumes of denials, complex accounts, or contractual reviews, as identified from strategic leadership requirements.
• Make necessary adjustments as required by plan reimbursement.
• Function as a departmental liaison for billing and collections support for internal and external customers, as required.
• Utilize systems tools and department resources to achieve production and quality targets for resolution of patient accounts.
• Investigates and responds to questions or requests for additional information in a timely and professional manner to ensure proper, timely and accurate payment of patient accounts.
• Attends in-services, classes and meetings related to all operations to the PFS department. Understands reimbursement of all 3rd party payers.

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.