Technical Denials Management Specialist III

UT Southwestern Medical Center • Dallas, TX

7h • Remote

About The Position

UT Southwestern Medical Center has a new opportunity available in the Revenue Cycle Department for the role of Technical Denials Management Specialist II. You will review, research and resolve claim denials and appeals for various insurance companies while identifying payment trends to maximize collections. The ideal candidate is well versed in working with EPIC Resolute.
Shift: Flex start 0600-0900, 8-hour shift
Work From Home (WFH): This is a WFH position. Applicants must live within the Greater Dallas-Fort Worth (DFW) area.
Our Culture:
The team 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.
Job Expectations:
Work both independently and collaboratively within a team to achieve production goals and deadlines.
Demonstrate a strong commitment to productivity by staying focused and on task without constant supervision.
Effectively communicate with colleagues, supervisors, and manager to ensure clarity, alignment, and successful outcomes.
Take ownership of assigned tasks and projects, demonstrating accountability and reliability in meeting expectations.
Adapt to changing priorities and work demands while maintaining a high level of quality and efficiency.
Proactively identify opportunities for process improvement and contribute innovative solutions to enhance overall productivity and teamwork.
Ability to contact medical insurance payers and resolve outstanding claims.
Ability to appeal denied claims and pursue appropriate action to overturn denials.
Serve as a team lead by providing day-to-day guidance, support, and direction to team members.
Handle complex, high-priority, or escalated accounts and work items that require advanced research and resolution.
Train and mentor new and existing team members on workflows, payer requirements, Epic processes, and departmental procedures.
Lead team workflow activities, help prioritize assignments, monitor inventory, and support completion of production goals and deadlines.
Assist the supervisor with operational needs, team communication, issue resolution, and follow-up on assigned initiatives.
Identify and escalate trends, barriers, or risks that may affect quality, productivity, reimbursement, or timely claim resolution.
Support quality assurance, process standardization, and continuous improvement efforts across the team.

Requirements

• Experience with Reconsideration, Redetermination, and Appeal with health insurance carriers.
• Knowledge and experience with handling and resolving NCCI edits, LCD/NDC, and bundling denials.
• Knowledge and experience with denial codes from the remittance/EOB.
• Knowledge and experience with contacting health insurance carriers.
• Ability to read and understand Explanation of Benefits.
• Ability to multitask and prioritize competing assignments.
• Experience contacting insurance companies and patients.
• Knowledge and experience with online payer portals.
• Epic experience.
• Experience with reviewing medical records.
• Advanced experience researching and resolving complex or escalated professional billing claims and denials.
• Experience monitoring work queues, aging inventory, productivity, and workflow priorities.
• Experience training staff and explaining processes, payer requirements, and resolution steps.
• Ability to analyze denial trends, identify root causes, and recommend process improvements.
• Ability to lead workflow activities and assist with quality review and operational follow-up.
• Outlook experience.
• Outlook Teams App experience.
• Excel experience.
• Medical Terminology.
• Payer Portal experience.
• Leadership and team coordination skills.
• Ability to coach, train, and provide constructive guidance to team members.
• Strong critical thinking, problem-solving, and decision-making skills.
• Professional communication and collaboration skills.
• Ability to remain organized, dependable, and adaptable while supporting multiple priorities.
• High School Diploma or Associate's Degree
• 4 years' experience in medical claims recovery and/or collections with High School Diploma.
• 2 years' experience in medical claims recovery and/or collections within a healthcare or insurance environment is preferred with Associates Degree.

Nice To Haves

• Applicants must live within the Greater Dallas-Fort Worth (DFW) area.

Responsibilities

• Review, research and resolve claim denials and appeals for various insurance companies while identifying payment trends to maximize collections.
• Work both independently and collaboratively within a team to achieve production goals and deadlines.
• Demonstrate a strong commitment to productivity by staying focused and on task without constant supervision.
• Effectively communicate with colleagues, supervisors, and manager to ensure clarity, alignment, and successful outcomes.
• Take ownership of assigned tasks and projects, demonstrating accountability and reliability in meeting expectations.
• Adapt to changing priorities and work demands while maintaining a high level of quality and efficiency.
• Proactively identify opportunities for process improvement and contribute innovative solutions to enhance overall productivity and teamwork.
• Contact medical insurance payers and resolve outstanding claims.
• Appeal denied claims and pursue appropriate action to overturn denials.
• Serve as a team lead by providing day-to-day guidance, support, and direction to team members.
• Handle complex, high-priority, or escalated accounts and work items that require advanced research and resolution.
• Train and mentor new and existing team members on workflows, payer requirements, Epic processes, and departmental procedures.
• Lead team workflow activities, help prioritize assignments, monitor inventory, and support completion of production goals and deadlines.
• Assist the supervisor with operational needs, team communication, issue resolution, and follow-up on assigned initiatives.
• Identify and escalate trends, barriers, or risks that may affect quality, productivity, reimbursement, or timely claim resolution.
• Support quality assurance, process standardization, and continuous improvement efforts across the team.
• 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.
• Contact 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.

Benefits

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100%25 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: Associate degree