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Technical Denials Management Specialist II

University of Texas Southwestern Medical Center
medical insurance, parental leave, paid time off, paid holidays, tuition reimbursement, remote work
United States, Texas, Dallas
5323 Harry Hines Boulevard (Show on map)
Feb 02, 2025
WHY UT SOUTHWESTERN? With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you'll discover a culture of teamwork, professionalism, and a rewarding career! JOB SUMMARY UT Southwestern Medical Center has a new opportunity available in the Revenue Cycle Department for the role of Technical Denials management Specialist II. 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 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 payer and resolve outstanding claims Ability to appeal denied claim and overturn the denial. Hard Skills Experience with Reconsideration, Redetermination, and Appeal with health insurance carriers. Knowledge and experience with handling and resolving NCCI edits, LCD/NCD, 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 Contacting insurance companies and patients Knowledge and experience with online payer portals Epic experience Experience with reviewing medical records Soft Skills Outlook experience Outlook Teams App experience Excel experience Medical Terminology Payer Portal experience BENEFITS UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include: 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 Learn more about these and other UTSW employee benefits! EXPERIENCE AND EDUCATION Required Education High School Diploma or Experience 2 years experience in medical claims recovery and/or collections required Preferred Education Associate's Degree JOB DUTIES Analyze payer denials by denial groupers and submit appeals. Contact patients and/or third party payers to resolve outstanding insurance balances and underpaid claims. Make necessary adjustments as required by plan reimbursement. Functions as a liaison between clinical departments and MSRDP management team. Completes special projects as assigned. Performs other duties as assigned. SECURITY AND EEO STATEMENT Security This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information. EEO Statement UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status. Benefits UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include: 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 Learn more about these and other UTSW employee benefits!