Technical Denials Management Specialist III

University of Texas Southwestern Medical Center • Dallas, TX

357d • Remote

About The Position

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.

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.

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.

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: Entry Level
• Industry: Educational Services
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees