WHY UT SOUTHWESTERN?
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 employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you’ll discover a culture of teamwork, professionalism, and a rewarding career!

JOB SUMMARY
Works under general supervision to provide policy analysis and recommendations to management related to reimbursement projects and functions.

BENEFITS
UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100% coverage for preventive healthcare-no copay
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer
• Learn more about these and other UTSW employee benefits!

EXPERIENCE AND EDUCATION
Required

• Education
  High School Diploma or GED

• Experience
  6 years of progressively responsible experience in medical insurance, medical billing or medical reimbursement.

Preferred

• Licenses and Certifications
  (CPC) CERT PROFESSIONAL CODER Upon Hire or
  Advanced Records Technician (ART), Upon Hire or
  (RRA) REGISTERED RECORDS ADMIN Upon Hire

JOB DUTIES

• Performs complex 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.
• Conducts meetings, organizes activities, reviews data analyses and reports, and creates reimbursement policies and procedures.
• Documents findings of inquiry and opinion letters. Maintains contract files, and files for research documents.
• Provides supervision to staff of lower grade in reimbursement operations.
• Performs other duties as assigned.

Ophthalmology Department Job Duties

• Insurance Verification / Eligibility, Referrals, Authorizations
• Identifies and verifies essential information pertaining to demographics, guarantor and subscriber
• Effectively communicates with team members to ensure everything is correct, referral on file, etc., for upcoming dates of service
• Monitors patient work queues/DAR to review accounts, insurance verification and/or referral/authorization
• Verifies patient insurance benefits and eligibility for all applicable scheduled services specific to the type of appointment, procedure and/or exam, and site of service via carrier websites or calling insurance companies
• Evaluates physician referral and authorization requirements to ensure requirements are met prior to date of service. Tracks accounts to resolution.
• Ensures exams are scheduled with proper patient class/Guarantor Account in Epic (Epic account type – P/F, Vision, W/C, etc.)
• Address and resolve plan alerts/errors and insurance filing order discrepancies
• Counsels clinical staff and/or patients regarding benefit information when “out of network” situations arise or other potential carrier concerns
• Address and resolve plan alerts/errors and insurance filing order discrepancies.
• Checking for referrals/authorizations
• Communicating/coordinating with other locations our providers see patients at (Parkland, CMC, JPS).
• Insurance denial follow-up
• Working insurance follow-up work queues
• Unpaid claims
• Submitting corrected claims. 
• Appealing claims
• Writes applicable appeal letters for denied claims
• Calling payors.
• Working credits for patients and insurance
• Charge Review/Entry
• Reviewing clinical notes/records to ensure accurate CPT and diagnosis codes are on the claim.
• Ordering of CPT codes
• Ensure appropriate DX are pointed to on each CPT code.
• Analyzes, investigates and resolves coding edits for complex drug billing, complex diagnostic studies, endoscopic, interventional and/or surgical procedures. This includes CPT, diagnosis, modifier, bundling, duplicate charge, and custom edit resolution. Requires strong knowledge of the carrier’s (Federal/State/Private) regulations and guidelines, internal revenue cycle coding processes and specialty specific service line billing practices. This position requires a high degree of organization and accuracy, and clear communication with providers on a regular basis to ensure services are well documented and meet all billing requirements. This position could possibly require resolving clinical and/or technical denials as well.
• Performs abstracting on E&M services, complex diagnostic studies, and/or endoscopic, interventional or surgical procedures. Requires the ability to read the progress note and or procedure/surgical results and confirm or change the CPT code(s), diagnosis code(s) and modifiers (if applicable). Requires strong knowledge of the carrier coverage policies and documentation requirements for specialty specific service lines. Must know the Medicare and Medicaid teaching physician documentation billing rules.
• Perform monthly charge reconciliation.
• Performs manual charge entry for all non-EpicCare and non-automated sites of services. This includes E&M visits and procedures across several centralized service lines. Depending on the clinical department they may be required to review and release charges from a computer assisted coding environment.
• Investigates and resolves coding and registration Epic Resolute Claim edits. Requires strong knowledge of Epic’s carrier registration filing order rules and billing rules.
• Must be able to work independently or within a group dynamic
• Familiar with EPIC, PDF
• Documents pertinent information in system based upon department documentation standards.
• Assists with training new teammates.
• Maintains department productivity standards.
• Encourages and coaches Reimbursement Specialists in this area
• Reviewing assigned work queues (charge review, edits, credits, interface errors, denials, etc.), DARs, surgery schedules/logs, missing charge reports.
• Making recommendations for assignment changes
• Ensuring projects assigned are completed on time and changes are implemented appropriately
• Assist in the development and implementation of policies/SOPs
• Contributes to the development of onboarding and training program for Reimbursement Specialists
• Demonstrates ongoing competency skills including above level problem solving skills and decision-making abilities
• Provides supervision to staff of lower grade on the Billing/Follow Up team

o   Serves as a resource to lower-level teammates. Requires a billing and coding knowledge level that provides guidance on and resolution to resolve claim denials, rejections and backend coding edits.

o   May lead, train, and/or mentor the work of lower-level designated Reimbursement Specialists to ensure quality of work and growth in knowledge and expertise.

• Promotes team engagement

SECURITY AND EEO STATEMENT
Security
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information. To the extent this position requires the holder to research, work on, or have access to critical infrastructure as defined in Section 113.001(2) of the Texas Business and Commerce Code, the ability to maintain the security or integrity of the critical infrastructure is a minimum qualification to be hired and to continue to be employed in the position.

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.