Eligibility Denial Specialist II

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 No. 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

• This Eligibility Denial Specialist II position is responsible for researching any denied claim based on eligibility to ensure correct payers are billed timely on submitted insurance claims.

• Managing and resolving outstanding correspondence related to refund requests from insurance carriers.

• Reviewing refund requests, determining their validity, disputing questionable refunds, and communicating directly with insurance companies to resolve issues.

• Completing dispute letters, conducting follow-ups, and handling appeals to ensure proper resolution of refund issues.

• Experienced in insurance billing, registration, and a keen understanding of the refund process will be key to successfully managing these tasks.

• Requires strong attention to detail, the ability to effectively communicate with insurance carriers, and a solid understanding of billing and refund processes within the healthcare industry.

Work Arrangement: This is a work-from-home (WFH) position. Candidates must reside within the Greater Dallas-Fort Worth (DFW) area. Additional details will be discussed during the interview process.

Work Schedule: Flexible start time between 6:00 a.m. and 9:00 a.m., with an 8-hour workday, Monday through Friday.

Job Expectations:

• Review and resolve refund request correspondence from insurance carriers, analyzing claims and documentation to determine validity.

• Dispute questionable refunds by researching and presenting evidence to insurance carriers and submitting dispute letters when necessary.

• Contact insurance carriers to resolve refund issues, follow up regularly to track the status, and manage the appeals process for incorrect or denied refunds.

• Process and issue refunds, ensuring compliance with company policies and accurate transactions.

• Utilize insurance billing knowledge to address discrepancies and leverage registration experience to resolve issues impacting refunds.

• Update insurance, registration and vfo to ensure charges are billed to correct insurance.

Hard Skills

• Experience with reviewing and resolving refund request correspondence from various insurance carriers.

• Knowledge and experience with submitting dispute letters to insurance carriers and following up to track the status of refund disputes.

• Knowledge and experience in processing and issuing refunds in compliance with company policies, along with a strong understanding of insurance billing practices and regulations to resolve billing discrepancies.

• Ability to communicate effectively with insurance carriers via phone or written communication to resolve refund issues.

• Experience with online payer portals to manage refund requests and disputes.

• Knowledge of registration processes to resolve issues impacting patient or insurance account details related to refunds.

• Ability to multitask and prioritize tasks effectively while handling multiple refund disputes and requests.

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 equivalent.
  

• Experience
  4 years medical billing, claims processing, and/or insurance eligibility experience.
  May consider medical billing certifications or graduate degrees in lieu of experience.

JOB DUTIES

• Review, research and resolve denied insurance claims based on eligibility through the billing system, including Medicaid, Medicare, Worker's Compensation, Mental Health payers and third-party payers.
• Interpret Explanation of Benefits from insurance companies on denied claims.
• Contact payers via website, phone and/or correspondence regarding claims denied for eligibility.
• Contact patients and assist with Coordination of Benefits or other coverage denials.
• Works in all professional billing service areas.
• Updates registration and demographic information in all hospital billing service areas.
• Resolves eligibility denials in all clearinghouse and payer rejection WQ's.
• Review and resolve any Visit Filing order changes and work advanced Visit Filing Order WQ's.
• Function as a liaison between clinical departments and third-party payers.
• Completes special projects as requested.
• Identifies problems and inconsistencies by using management reports; summarizes findings and makes recommendations to resolve billing issues in an effort to maximize collections.
• Duties performed may include one or more of the following core functions: (a) Directly interacting with or caring for patients; (b) Directly interacting with or caring for human-subjects research participants; (c) Regularly maintaining, modifying, releasing or similarly affecting patient records (including patient financial records); or (d) Regularly maintaining, modifying, releasing or similarly affecting human-subjects research records.
• Performs other duties as assigned.

Knowledge, Skills and Abilities

• Work requires ability to work in a fast paced, production-oriented environment.
• Work requires Basic working knowledge of spreadsheet and word processing software.
• Work requires knowledge of insurance billing and various types of health insurance.
• Work requires strong oral and written communication skills, including the use of medical terminology.
• Work requires strong organizational skills
• Work requires the ability to analyze problems, develop solutions and implement new procedures.

PHYSICAL REQUIREMENTS/WORKING CONDITIONS

Working Conditions

• Office Setting

Salary Information
Salary is commensurate with education, skills, and relevant experience.

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
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.