Technical Denials Management Specialist III - Surgical Billing Follow Up
Categories: Insurance / Billing
Department: MSRDP Team 4 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
Associates degree and two (2) years experience with medical claims recovery and/or collections within a healthcare or insurance environment is preferred or High School diploma four (4) years experience with medical claims recovery and/or collections rules and regulations is required.
1. Contact payers, via website, phone and/or correspondence, regarding reimbursement of unpaid accounts over thirty (30) days or more, also researching and following up on denials and requests for additional information.
2. Interpret Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection.
3. Make necessary adjustments as required by plan reimbursement.
4. Performs payment validation by utilizing internal and/or external resources to ensure proper reimbursement.
5. Reviews, research and appeal partially denied claims for reconsideration.
6. Responsible for contacting patients to gain additional information required to resolve an outstanding insurance balance.
7. Functions as resource person for departmental personnel to answer questions and assists with problem resolution.
Performs other duties as assigned.
This position will responsible for the claims follow-up for the Department of OBGYN and to assist the department. As of 6/20/17, the OBGYN work queue has a volume of 10,097 active invoices outstanding. This person will handle massive special projects for OBGYN as well. This person would be expected to maintain a quality of 98% accuracy while meeting and/or exceeding the production standard of 40 invoices per day. I currently have 4 follow-up staff that help with that department. The volume has and will continue to increase due to addition of the Moncrief Ft Worth location, and several surgical sites with THR, Plaza, and JPS.
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.