Reimbursement Specialist - Ophthalmology - Clinic
Categories: Insurance / Billing
Department: Ophthlmlgy Clnc
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 GED and four (4) years progressively responsible experience in medical insurance, medical billing, or medical reimbursement. Certified Professional Coder (CPC), Advanced Records Technician (ART), or Registered Records Administrator (RRA) preferred.
Any equivalent combination of related education and/or experience may be considered for the above.
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.
Obtain insurance verification and authorizations for specific Ophthalmology visits/treatments. Communicate insurance, authorizations, balances and patient responsibility payments to clinic, patient and or family in advance of patient visit. Review and interpret insurance policy language.
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.