Technical Denial Management Specialist II

The University of Texas Southwestern Medical Center; Dallas (TX); Ibrido; USD 55.000 - 75.000; Tempo pieno

Descrizione del lavoro

The University of Texas Southwestern Medical Center is seeking a Technical Denials Management Specialist II to review, research, and resolve claim denials and appeals for various insurers. The role emphasizes follow-up and resolution of denied claims, with no direct billing or coding responsibilities.

The successful candidate should have experience in medical claims recovery and hold strong communication, organization, and analytical skills.

Competenze

• Education: High School Diploma required; Associate degree preferred.
• Experience: 2 years in medical claims recovery/collections required.
• Knowledge: CMS 1500, ICD-9, CPT coding preferred.
• Requires ability to work in a fast-paced, production-oriented environment with strong customer service.

Mansioni

• Analyze payer denials by denial groupers and submit appeals.
• Contact patients/third-party payers to resolve insurance balances and underpaid claims.
• Make adjustments as required by plan reimbursement.
• Serve as liaison between clinical departments and MSRDP management.
• Complete special projects as assigned and perform other duties as needed.

Conoscenze

Self-starter

Teamwork

Communication

High-volume work

Fast-paced environment

Customer service

Medical billing/collections

Organizational skills

Regulations knowledge

CMS 1500 knowledge

Alpha-numeric data entry

Professional demeanor

Written & verbal communication

Medicare/Medicaid knowledge

Formazione

High School Diploma

Associate's degree (preferred)

Descrizione del lavoro

JOB INFORMATION

Job Code: 7004

Job Title: TECHNL DENIALS MGMT SPEC II

Date Last Edited:3/13/2024

FLSA Status: N

JOB SUMMARY

UT Southwestern Medical Center has an opening within the Revenue Cycle Department team for a Technical Denials Management Specialist II. The successful candidate will review, research, and resolve claim denials and appeals for various insurance companies while identifying payment trends in an effort to maximize collections. This role focuses on follow-up and resolution of denied claims and does not involve direct billing or coding responsibilities. A successful candidate should have, but not be limited to the following skills:

• Capable of reviewing Explanation of Benefits (EOB) from payors to determine how the claims were managed.
• Contacting insurance carriers to check on the status of claims, appeals, and insurance verification.
• Knowledgeable with payors including Managed Care, Commercial, Medicare, and Medicaid.
• Preparing/Submitting appeals related to denied services.

This is a work from home (WFH) opportunity. The successful applicant must live within the Greater DFW area and be available to come to the office for equipment pickup, office meetings, and training. Additional details regarding WFH will be discussed as part of the interview process.

ESSENTIAL FUNCTIONS

Job Duties

• Analyze payer denials by denial groupers and submit appeals.
• Contact patients and/or third-party payers to resolve outstanding insurance balances and underpaid claims.
• Make necessary adjustments as required by plan reimbursement.
• Functions as a liaison between clinical departments and MSRDP management team.
• Completes special projects as assigned.
• Performs other duties as assigned.

QUALIFICATIONS

Education and Experience

Required

• Education
  High School Diploma or

• Experience
  2 years' experience in medical claims recovery and/or collections required

Preferred

• Education
  Associate's degree

Knowledge, Skills and Abilities

• Work requires a self-starter, with ability to work well as part of a team and independently.
• Work requires ability to communicate effectively with patients, insurance companies, clinical staff and management.
• Work requires ability to handle large volumes of work.
• Work requires ability to work in a fast paced, production-oriented environment.
• Work requires excellent customer service skills.
• Work requires experience in Medical Billing, Accounts Receivables, and/or Collections within a healthcare or insurance environment.
• Work requires good organizational, flexibility and analytical skills when resolving more complex unpaid claims.
• Work requires knowledge of billing and/or collections and regulations.
• Work requires knowledge of CMS 1500, ICD-9, and CPT coding is preferred.
• Work requires one to exhibit excellent work ethics and commitment to job responsibilities.
• Work requires one to possess a professional and courteous demeanor while being assertive and confident in their collection efforts.
• Work requires one to possess quick and accurate alpha/numeric data entry skills.
• Work requires presence of a positive image that reflects well on the organization.
• Work requires strong written and verbal communication skills.
• Work requires understanding of the requirements of Medicaid, Medicare and insurance billing.

PHYSICAL DEMANDS/WORKING CONDITIONS

• Physical Demands
  Talking
• Working Conditions
  Office Setting

PACT STATEMENT

• The following is the acronym, "PACT", and is fundamental to all non-clinical positions at UT Southwestern Medical Center:
• P-Problem Solving Employees take ownership in solving problems effectively, efficiently, and to the satisfaction of customers, or managers. They show initiative in addressing areas of concern before they become problems.
• A-Ability, Attitude and Accountability Employees exhibit ability to perform their job and conduct themselves in a professional and positive manner reflecting a professional environment readily assuming obligations in a dependable and reliable manner.
• C-Communication, Contribution, and Collaboration Who are our customers? Anyone who requests our help, needs our work product, or receives our services. Employees focus on customer service with creative solutions while improving the customer experience through clear, courteous, and timely delivery and communication. Sharing ideas with others helps expand our contribution to department goals.
• T-Teamwork Employees work to contribute to the department's success by supporting co-workers, promoting excellence in work product and customer service, and in maintaining a satisfying, caring environment for each other.

Salary

Salary Negotiable

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 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.