Claims Edit Specialist II

UT Southwestern Medical Center • Dallas, TX

1d • Remote

About The Position

The Claims Edit Specialist is responsible for reviewing and processing basic and complex insurance claim edits in a timely manner under direct supervision of supervisor. This position works under direct supervisor of the department supervisor and is expected to complete assigned claims in a timely manner while following established procedures and guidelines. Candidate must live in the Greater Dallas-Fort Worth (DFW) area. Shift: 8-hour days, flex shift. Our team’s culture is Love Based, which thrives on mutual respect, empathy, and support, fostering an environment where every member feels valued and empowered. It prioritizes open communication, collaboration, and understanding, creating a cohesive and inclusive community where individuals can flourish personally and professionally. Love Based cultivates a culture where kindness, compassion, and appreciation are foundational principles, leading to greater creativity, productivity, and fulfillment for all team members.

Requirements

• Epic experience
• Knowledge and experience with registration
• Knowledge and experience with health insurance carriers
• Ability to read and understand Explanation of Benefits
• Ability to multitask.
• Contacting insurance companies and patients
• Outlook experience
• Team experience
• Excel experience
• Medical Terminology
• High School Diploma Or equivalent
• 4 years Experience with medical billing or claims processing, knowledge of billing and/or collections rules and regulations
• May consider education in lieu of experience

Responsibilities

• Reviews and processes basic and complex insurance claim edits through the billing system.
• Utilizes vendor and third party websites for eligibility/benefit verification and authorization information. Updates the billing system accordingly.
• Reposts and resubmits claims based on research findings and billing system updates.
• Works in all professional billing service areas.
• Updates registration and demographic information in at least two hospital billing service areas.
• Assists lower level specialists. May escalate issues above knowledge base to higher level specialist or supervisor.
• Performs other duties as assigned.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED