PFS REP II

UT Southwestern Medical Center • Dallas, TX

6d

About The Position

The PFS REP II analyzes payer underpayments, variances, and denials; identifies and escalates trends; recommends resolutions; and files professional appeals in accordance with contractual agreements and UT Southwestern policy. The role processes assigned account volumes within established production guidelines and workflow timeframes. It also conducts outbound calls and payer website inquiries to validate claim receipt and adjudication status, and documents work and communications according to policy.

The representative handles client-based, research, and UT Southwestern special arrangements, including calculating physician and hospital shares, coordinating transfers with MSP, and working with internal departments to invoice clients and bill claims correctly. The role works across payer types and supports account-resolution projects and initiatives, including high-volume denials, complex accounts, and contractual reviews. It makes reimbursement-related adjustments, serves as a billing and collections liaison for internal and external customers, and uses department systems and resources to meet production and quality targets. The representative responds to information requests professionally and promptly, maintains passing QA scores, attends department-related in-services, classes, and meetings, and understands third-party payer reimbursement.

Requirements

• High school diploma.
• Five years of hospital or medical billing experience.

Nice To Haves

• Bachelor's degree.
• Hospital billing and collections experience.
• Traditional Medicare billing and follow-up experience.

Responsibilities

• Analyze payer underpayments, variances, and denials; escalate trends, recommend resolutions, and file appeals according to contractual agreements and UT Southwestern policy.
• Process allocated account volumes within established production guidelines and workflow timeframes.
• Conduct outbound calls and payer website inquiries to validate receipt of medical claims and check adjudication status within established timeframes.
• Access, navigate, and manage account information through phone calls and payer websites; document work and calls according to policy, including contact information and expected outcomes.
• Handle client-based, research, and UT Southwestern special arrangements, including calculating physician and hospital shares, coordinating physician-share transfers with MSP, and working with departments to invoice clients and bill claims correctly.
• Work across payer types and support special account-resolution projects and initiatives, including large volumes of denials, complex accounts, and contractual reviews.
• Make adjustments required by plan reimbursement.
• Serve as a departmental liaison for billing and collections support for internal and external customers.
• Use systems tools and departmental resources to achieve patient-account resolution production and quality targets.
• Investigate and respond to questions or requests for additional information in a timely and professional manner to support accurate payment of patient accounts.
• Maintain passing QA scores.
• Attend in-services, classes, and meetings related to PFS department operations; understand reimbursement of third-party payers.

Benefits

• PPO medical plan available day one at no cost for full-time employee-only coverage.
• 100% coverage for preventive healthcare with 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.
• Healthcare, paid holidays, on-site childcare, and wage and merit increases are also mentioned in the introductory benefits statement.

What This Job Offers

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