MSRDP Eligibility Denials Specialist I - MSRDP Billing Operations - Physician Billing & Support
Categories: Insurance / Billing
Department: MSRDP Dmgrphcs Admin
Full/Part Time/PRN: Full-Time
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information
Experience and Education
High school diploma or equivalent and four (4) years medical billing, claims processing, and/or collections experience; Associates degree preferred. Requires working knowledge of Epic Resolute.
1. Review, research and resolve basic denied insurance claims based on eligibility through the billing system, including Medicaid, Medicare, Worker's Compensation, Mental Health payers and third party payers.
2. Interpret Explanation of Benefits from insurance companies on denied claims.
3. Contact payers via website, phone and/or correspondence regarding claims denied for eligibility.
4. Contact patients and assist with Coordination of Benefits or other coverage denials.
5. Works in one professional billing service areas. May work in dual professional billing services areas.
6. Review and resolve any Visit Filing order changes.
7. Functions as a liaison between clinical departments and third party payers.
8. Completes special projects as requested.
9. Identifies problems and inconsistencies by using management reports; summarizes findings and makes recommendations to resolve billing issues in an effort to maximize collections.
10. 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.
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; gender, including sexual harassment; age; disability; citizenship; and veteran status. In addition, it is UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.