Technical Denials Management Specialist III

UT Southwestern Medical Center•Dallas, TX

4d•Hybrid

About The Position

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

Requirements

High School Diploma or Associate's Degree
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.
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 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.

Nice To Haves

Work requires knowledge of CMS 1500, ICD-9, and CPT coding is preferred.

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 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.