Technical Denials Management Specialist III
The University of Texas Southwestern Medical Center, Dallas, Texas, United States, 75215
Overview
Job Description - Technical Denials Management Specialist III (26000031) – UT Southwestern Medical Center
JOB SUMMARY
UT Southwestern Medical Center has an opening within the Revenue Cycle Department team for a Technical Denials Management Specialist III. The successful candidate’s experience should include but is not limited to the following skills:
Capable of reviewing Explanation of Benefits (EOB) from payors to determine how the claims were managed.
Contacting insurance carriers to check on the status of claims, appeals, and insurance verification.
Review, research and resolve claim denials and appeals for various insurance companies while identifying payment trends in an effort to maximize collections.
Knowledgeable with payors including Managed Care, Commercial, Medicare, and Medicaid
Preparing/Submitting appeals related to denied services.
This is a work from home (WFH) opportunity. The successful applicant must live within the Greater DFW area and be available to come to the office for equipment pickup, office meetings, and training. Additional details regarding WFH will be discussed as part of the interview process.
Shift: 8-hour days, Monday through Friday
Responsibilities
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 request 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.
Perform payment validation by utilizing internal and/or external resources to ensure proper reimbursement.
Review, research and appeal partially denied claims for reconsideration.
Responsible for contacting patients to gain additional information required to resolve outstanding insurance balances.
Function as resource person for departmental personnel to answer questions and assist with problem resolution.
Review and resolve provider NPI/TPI claim edits rejections.
Review and resolve provider NPI/TPI claim denial.
Assist with working Claim Edit Work queues.
Assist with working Team Lead Work queues.
Assist with New Hire Training.
Performs other duties as assigned.
Qualifications Education and Experience
Required
Education High School Diploma or Associate's Degree
Experience 4 years experience in medical claims recovery and/or collections with High School Diploma. or 2 years experience in medical claims recovery and/or collections within a healthcare or insurance environment is preferred with Associates Degree.
Knowledge, Skills and Abilities
Work requires a self-starter, with ability to work well as part of a team and independently.
Work requires ability to communicate effectively with patients, insurance companies, clinical staff and management.
Work requires ability to handle large volumes of work.
Work requires ability to work in a fast paced, production oriented environment.
Work requires excellent customer service skills.
Work requires experience in Medical Billing, Accounts Receivables, and/or Collections within a healthcare or insurance environment.
Work requires good organizational, flexibility and analytical skills when resolving more complex unpaid claims.
Work requires knowledge of billing and/or collections and regulations.
Work requires knowledge of CMS 1500, ICD-9, and CPT coding is preferred.
Work requires one to exhibit excellent work ethics and commitment to job responsibilities.
Work requires one to possess a professional and courteous demeanor while being assertive and confident in their collection efforts.
Work requires one to possess quick and accurate alpha/numeric data entry skills.
Work requires presence of a positive image that reflects well on the organization.
Work requires strong written and verbal communication skills.
Work requires understanding of the requirements of Medicaid, Medicare and insurance billing.
Physical Demands / Working Conditions
Physical Demands Talking
Working Conditions Office Setting
Salary Salary Negotiable
Security This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.
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.
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.
Copyright 2017. The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas 75390, Phone 214-648-3111
#J-18808-Ljbffr
JOB SUMMARY
UT Southwestern Medical Center has an opening within the Revenue Cycle Department team for a Technical Denials Management Specialist III. The successful candidate’s experience should include but is not limited to the following skills:
Capable of reviewing Explanation of Benefits (EOB) from payors to determine how the claims were managed.
Contacting insurance carriers to check on the status of claims, appeals, and insurance verification.
Review, research and resolve claim denials and appeals for various insurance companies while identifying payment trends in an effort to maximize collections.
Knowledgeable with payors including Managed Care, Commercial, Medicare, and Medicaid
Preparing/Submitting appeals related to denied services.
This is a work from home (WFH) opportunity. The successful applicant must live within the Greater DFW area and be available to come to the office for equipment pickup, office meetings, and training. Additional details regarding WFH will be discussed as part of the interview process.
Shift: 8-hour days, Monday through Friday
Responsibilities
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 request 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.
Perform payment validation by utilizing internal and/or external resources to ensure proper reimbursement.
Review, research and appeal partially denied claims for reconsideration.
Responsible for contacting patients to gain additional information required to resolve outstanding insurance balances.
Function as resource person for departmental personnel to answer questions and assist with problem resolution.
Review and resolve provider NPI/TPI claim edits rejections.
Review and resolve provider NPI/TPI claim denial.
Assist with working Claim Edit Work queues.
Assist with working Team Lead Work queues.
Assist with New Hire Training.
Performs other duties as assigned.
Qualifications Education and Experience
Required
Education High School Diploma or Associate's Degree
Experience 4 years experience in medical claims recovery and/or collections with High School Diploma. or 2 years experience in medical claims recovery and/or collections within a healthcare or insurance environment is preferred with Associates Degree.
Knowledge, Skills and Abilities
Work requires a self-starter, with ability to work well as part of a team and independently.
Work requires ability to communicate effectively with patients, insurance companies, clinical staff and management.
Work requires ability to handle large volumes of work.
Work requires ability to work in a fast paced, production oriented environment.
Work requires excellent customer service skills.
Work requires experience in Medical Billing, Accounts Receivables, and/or Collections within a healthcare or insurance environment.
Work requires good organizational, flexibility and analytical skills when resolving more complex unpaid claims.
Work requires knowledge of billing and/or collections and regulations.
Work requires knowledge of CMS 1500, ICD-9, and CPT coding is preferred.
Work requires one to exhibit excellent work ethics and commitment to job responsibilities.
Work requires one to possess a professional and courteous demeanor while being assertive and confident in their collection efforts.
Work requires one to possess quick and accurate alpha/numeric data entry skills.
Work requires presence of a positive image that reflects well on the organization.
Work requires strong written and verbal communication skills.
Work requires understanding of the requirements of Medicaid, Medicare and insurance billing.
Physical Demands / Working Conditions
Physical Demands Talking
Working Conditions Office Setting
Salary Salary Negotiable
Security This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.
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.
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.
Copyright 2017. The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas 75390, Phone 214-648-3111
#J-18808-Ljbffr