Technical Denials Management Specialist III
Job Description
About the Role
Title: Technical Denials Management Specialist III
Location: Dallas United States
Job Description:
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
The Revenue Cycle Department has a new position available for Technical Denials Management Specialist III. You will be responsible for billing applicable payers and ensuring timely collections of various insurance claims; will review, research, and appeal complex denials and inadequate payments from third-party payers while identifying trends of payment problems in an effort to maximize collections. The successful candidates’ duties will include but not be limited to the following:
Proficient in working with various payors, including Managed Care, Commercial, Medicare, and Medicaid.
Experienced in managing collections by resolving denials and preparing and submitting appeals for denied services.
Skilled in reviewing Explanation of Benefits (EOB) documents from payors to analyze claim processing outcomes.
Contact insurance carriers to check on the status of claims, appeals, mailing, registration, and insurance verification.
Shift: Flex, start between 0600-0900, Monday through Friday
Work From Home (WFH): This is a WFH position, however, the successful applicant must live within the Greater DFW area and available to come to the office for equipment pickup/exchange, office meetings, trainings, etc. Additional details related to this shall be discussed as part of the interview process.
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
Associate’s Degree
Experience
4 years experience in medical claims recovery and/or collections with High School Diploma. or
2 years years experience in medical claims recovery and/or collections within a healthcare or insurance environment is preferred with Associates Degree.
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 request for additional information.
Interpret Manage 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.
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.
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.
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!
