Reimbursement Specialist - Ophthalmology Billing/Follow-Up

Davita Inc.; Dallas (TX); Remote; USD 50,000 - 65,000; Full time

Job summary

UT Southwestern Medical Center is seeking a Reimbursement Specialist to handle insurance follow-ups, claims submissions, and eligibility verification. This role supports the ophthalmology department and allows for primarily remote work, fostering a culture of teamwork and professionalism.

Benefits

PPO medical plan available day one

Paid Time Off available day one

Retirement Programs through TRS

Paid Parental Leave Benefit

Tuition Reimbursement

Qualifications

• 4 years of experience in medical insurance, billing, or reimbursement.
• Ability to work from home with occasional office meetings.
• Familiarity with insurance verification and claims submission.

Responsibilities

• Follow up on insurance denials and submit corrected claims.
• Perform policy analysis and manage reimbursement projects.
• Document findings and maintain accurate contract information.

Skills

Insurance denial follow-up

Working independently

Communication

Education

High School Diploma or equivalent

Tools

EPIC

PDF

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, 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

UT Southwestern Medical Center is the preeminent medical facility in North Texas and one of the leading hospital systems nationwide. We have a new opening within the Department of Ophthalmology for a Reimbursement Specialist. The successful candidates' duties will include but not be limited to the following:

• Insurance denial follow-up




• Working insurance follow-up work queues


• Unpaid claims


• Submitting corrected claims.




• Insurance eligibility/verification


• Checking for referrals/authorizations


• Communicating/coordinating with other locations our providers see patients at (Parkland, CMC, JPS).


• Working credits for patients and insurance


• Charge Review/Entry


• Must be able to work independently or within a group dynamic


• Familiar with EPIC, PDF

Primarily work from home (Monday-Friday), estimated at 95% (may occasionally come to the office for team meetings, etc.). Cannot consider candidates who do not live in Texas. Additional details shall be discussed during the interview process.

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
  4 years of progressively responsible experience in medical insurance, medical billing or medical reimbursement.

Preferred

• Licenses and Certifications
  (CPC) CERT PROFESSIONAL CODER Upon Hire or
  Advanced Records Technician (ART) Upon Hire or
  (RRA) REGISTERED RECORDS ADMIN Upon Hire

JOB DUTIES

• Performs policy analysis for managed care issues by reviewing contracts, writing clause revisions, making recommendations for reimbursement policy changes, reviewing reports and financial data, and analyzing fee schedules, encounter forms, diagnosis, and procedure codes; ensures contracts reflect appropriate business decisions.


• Ensures projects related to reimbursement issues are completed on time and changes are implemented appropriately by conducting meetings, organizing activities, reviewing data analyses and reports, and creating reimbursement policies and procedures.


• Documents findings by writing inquiry letters, constructing opinion letters, maintaining contract files, and maintaining files for research documents.


• Performs other duties as assigned.

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. To the extent this position requires the holder to research, work on, or have access to critical infrastructure as defined in Section 113.001(2) of the Texas Business and Commerce Code, the ability to maintain the security or integrity of the critical infrastructure is a minimum qualification to be hired and to continue to be employed in the position.

EEO Statement
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.

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!