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 patients and employees. With over 20,000 employees, we are committed to continuing our growth with the best professionals in the healthcare industry. We invite you to be a part of the UT Southwestern team where you’ll discover teamwork, professionalism, and consistent opportunities for growth.

The Revenue Cycle Department team has a new position available for Technical Denials Management Specialist III. The successful candidates’ duties will include but not be limited to the following:

• Knowledgeable with payors including Managed Care, Commercial, Medicare, and Medicaid.
• Collections – Resolve denials. Prepare appeals related to denied services.
• Capable of reviewing the Explanation of Benefits (EOB) from payors to determine how the claim was handled.
• Contact insurance carriers to check on the status of claims, appeals, mailing, registration, and insurance verification.
• Customer Service background preferred Will be responsible for taking live calls

Work From Home: This is a work from home (WFH) opportunity; however, the successful applicant must live within the Greater DFW area and be available to come to the office for equipment pickup/exchange, office meetings, trainings, etc. Additional details regarding to WFH shall be discussed as part of the interview process.

Shift: Flex shift, 8-hour days, Monday through Friday 

Quick tip(s):

Please review the section entitled experience/education and focus on the job requirements.

Make sure you include the experience listed under the requirements section on your application. 

EXPERIENCE | EDUCATION:

REQUIRED:

• High School Diploma
• Four (4) years’ experience in medical claims recovery and/or collections required.
• Associate degree and two (2) years’ experience in medical claims recovery and/or collections within a healthcare or insurance environment is preferred.

JOB DUTIES:

• 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.
• Interpret Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection.
• Make necessary adjustments as required by plan reimbursement.
• Performs payment validation by utilizing internal and/or external resources to ensure proper reimbursement.
• Reviews, research, and appeal partially denied claims for reconsideration.
• Responsible for contacting patients to gain additional information required to resolve an outstanding insurance balance.
• Functions as resource person for departmental personnel to answer questions and assists with problem resolution.
• Performs other duties as assigned. 

SECURITY:

This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

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.