Technical Denials Management Specialist III

%3Cp%3E%3Cstrong%3EWHY UT SOUTHWESTERN?%3C/strong%3E%3Cbr%3EWith 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 %3Ca href=%22https://www.utsouthwestern.edu/newsroom/articles/year-2022/july-us-news-best-hospital.html%22 target=%22_blank%22%3EU.S. News %26amp; World Report%3C/a%3E, 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%27ll discover a culture of teamwork, professionalism, and a rewarding career!%26nbsp;%3Cbr%3E%3Cbr%3E%3Cstrong%3EJOB SUMMARY%3C/strong%3E%3Cbr%3EUT 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.%26nbsp;%3C/p%3E%3Cul style=%22margin-top:0in;%22 type=%22disc%22%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l2 level1 lfo1;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EShift: Flex start 0600-0900, 8-hour shift%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l2 level1 lfo1;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EWork From Home (WFH): This is a WFH position. Applicants must live within the Greater DFW area.%26nbsp;%26nbsp;%3C/span%3E%3C/li%3E%3C/ul%3E%3Cp class=%22xxmsonormal%22%3E%3Ca href=%22https://utsw.taleo.net/enterprise/UT%20Southwestern%20Medical%20Center%20has%20a%20new%20opportunity%20available%20in%20the%20Revenue%20Cycle%20Department%20team%20for%20the%20role%20of%20Technical%20Denials%20management%20Specialist%20II.%C2%A0%20%20Our%20Culture:%20%20Our%20teams%20culture%20is%20Love%20Based,%20which%20thrives%20on%20mutual%20respect,%20empathy,%20and%20support,%20fostering%20an%20environment%20where%20every%20member%20feels%20valued%20and%20empowered.%20It%20prioritizes%20open%20communication,%20collaboration,%20and%20understanding,%20creating%20a%20cohesive%20and%20inclusive%20community%20where%20individuals%20can%20flourish%20personally%20and%20professionally.%20Love%20Based%20cultivates%20a%20culture%20where%20kindness,%20compassion,%20and%20appreciation%20are%20foundational%20principles,%20leading%20to%20greater%20creativity,%20productivity,%20and%20fulfillment%20for%20all%20team%20members.%20%20%C2%A0Job%20Expectations:%20%20Work%20both%20independently%20and%20collaboratively%20within%20a%20team%20to%20achieve%20production%20goals%20and%20deadlines.%20Demonstrate%20a%20strong%20commitment%20to%20productivity%20by%20staying%20focused%20and%20on%20task%20without%20constant%20supervision.%20Effectively%20communicate%20with%20colleagues,%20supervisors,%20and%20manager%20to%20ensure%20clarity,%20alignment,%20and%20successful%20outcomes.%20Take%20ownership%20of%20assigned%20tasks%20and%20projects,%20demonstrating%20accountability%20and%20reliability%20in%20meeting%20expectations.%20Adapt%20to%20changing%20priorities%20and%20work%20demands%20while%20maintaining%20a%20high%20level%20of%20quality%20and%20efficiency.%20Proactively%20identify%20opportunities%20for%20process%20improvement%20and%20contribute%20innovative%20solutions%20to%20enhance%20overall%20productivity%20and%20teamwork%20Ability%20to%20contact%20medical%20insurance%20payer%20and%20resolve%20outstanding%20claims%20Ability%20to%20appeal%20denied%20claim%20and%20overturn%20the%20denial.%20%20%C2%A0Hard%20Skills%20%20Experience%20with%20Reconsideration,%20Redeterminatio%22 target=%22_blank%22%3EOur Culture:%3C/a%3E%3C/p%3E%3Cp class=%22xxmsonormal%22%3EThe 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. %26nbsp;%3C/p%3E%3Cp class=%22xxmsonormal%22%3E%3Ca href=%22https://utsw.taleo.net/enterprise/Job%20Expectations:%22 target=%22_blank%22%3EJob Expectations:%3C/a%3E%3C/p%3E%3Cul style=%22margin-top:0in;%22 type=%22disc%22%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l1 level1 lfo2;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EWork both independently and collaboratively within a team to achieve production goals and deadlines.%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l1 level1 lfo2;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EDemonstrate a strong commitment to productivity by staying focused and on task without constant supervision.%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l1 level1 lfo2;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EEffectively communicate with colleagues, supervisors, and manager to ensure clarity, alignment, and successful outcomes.%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l1 level1 lfo2;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3ETake ownership of assigned tasks and projects, demonstrating accountability and reliability in meeting expectations.%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l1 level1 lfo2;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EAdapt to changing priorities and work demands while maintaining a high level of quality and efficiency.%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l1 level1 lfo2;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EProactively identify opportunities for process improvement and contribute innovative solutions to enhance overall productivity and teamwork%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l1 level1 lfo2;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EAbility to contact medical insurance payer and resolve outstanding claims%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l1 level1 lfo2;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EAbility to appeal denied claim and overturn the denial.%3C/span%3E%3C/li%3E%3C/ul%3E%3Cp class=%22xxmsonormal%22%3E%3Ca href=%22https://utsw.taleo.net/enterprise/Hard%20Skills%22 target=%22_blank%22%3EHard Skills%26nbsp;%3C/a%3E%3C/p%3E%3Cul style=%22margin-top:0in;%22 type=%22disc%22%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l3 level1 lfo3;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EExperience with Reconsideration, Redetermination, and Appeal with health insurance carriers.%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l3 level1 lfo3;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EKnowledge and experience with handling and resolving NCCI edits, LCD/NCD, and bundling denials. %26nbsp;%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l3 level1 lfo3;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EKnowledge and experience with denial codes from the remittance/EOB%26nbsp;%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l3 level1 lfo3;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EKnowledge and experience with contacting health insurance carriers%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l3 level1 lfo3;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EAbility to read and understand Explanation of Benefits%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l3 level1 lfo3;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EAbility to multitask Contacting insurance companies and patients%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l3 level1 lfo3;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EKnowledge and experience with online payer portals%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l3 level1 lfo3;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EEpic experience with reviewing medical records %26nbsp;%3C/span%3E%3C/li%3E%3C/ul%3E%3Cp class=%22xxmsonormal%22%3E%3Ca href=%22https://utsw.taleo.net/enterprise/Soft%20Skills%22 target=%22_blank%22%3ESoft Skills%3C/a%3E%3C/p%3E%3Cul style=%22margin-top:0in;%22 type=%22disc%22%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l0 level1 lfo4;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EOutlook experience%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l0 level1 lfo4;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EOutlook Teams App experience%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l0 level1 lfo4;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EExcel experience%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l0 level1 lfo4;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EMedical Terminology%3C/span%3E%3C/li%3E%3Cli class=%22xxmsonormal%22 style=%22mso-list:l0 level1 lfo4;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EPayer Portal experience%3C/span%3E%3Cbr%3E%26nbsp;%3C/li%3E%3C/ul%3E%3Cp%3E%3Cstrong%3EBENEFITS%3C/strong%3E%3Cbr%3EUT 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:%3C/p%3E%3Cul%3E%3Cli%3EPPO medical plan, available day one at no cost for full-time employee-only coverage%3C/li%3E%3Cli%3E100% coverage for preventive healthcare-no copay%3C/li%3E%3Cli%3EPaid Time Off, available day one%3C/li%3E%3Cli%3ERetirement Programs through the Teacher Retirement System of Texas (TRS)%3C/li%3E%3Cli%3EPaid Parental Leave Benefit%3C/li%3E%3Cli%3EWellness programs%3C/li%3E%3Cli%3ETuition Reimbursement%3C/li%3E%3Cli%3EPublic Service Loan Forgiveness (PSLF) Qualified Employer%3C/li%3E%3Cli%3E%3Ca href=%22http://jobs.utsouthwestern.edu/benefits/#top%22 target=%22_blank%22%3ELearn more about these and other UTSW employee benefits!%3C/a%3E%3C/li%3E%3C/ul%3E%3Cp%3E%3Cbr%3E%3Cbr%3E%3Cstrong%3EEXPERIENCE AND EDUCATION%3C/strong%3E%3Cbr%3E%3Cbr%3E%3Cstrong%3ERequired%3C/strong%3E%3C/p%3E%3Cul%3E%3Cli%3E%3Cstrong%3EEducation%3C/strong%3E%3Cbr%3EHigh School Diploma or%26nbsp;%3Cbr%3EAssociate%27s Degree%26nbsp;%3Cbr%3E%26nbsp;%3C/li%3E%3C/ul%3E%3Cul%3E%3Cli%3E%3Cstrong%3EExperience%3C/strong%3E%3Cbr%3E4 years experience in medical claims recovery and/or collections with High School Diploma. or%26nbsp;%3Cbr%3E2 years experience in medical claims recovery and/or collections within a healthcare or insurance environment is preferred with Associates Degree.%26nbsp;%3Cbr%3E%26nbsp;%3C/li%3E%3C/ul%3E%3Cp%3E%3Cbr%3E%3Cstrong%3EJOB DUTIES%3C/strong%3E%3C/p%3E%3Cul%3E%3Cli%3EContact 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.%3C/li%3E%3Cli%3EInterpret Manage Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection.%3C/li%3E%3Cli%3EMake necessary adjustments as required by plan reimbursement.%3C/li%3E%3Cli%3EPerform payment validation by utilizing internal and/or external resources to ensure proper reimbursement.%3C/li%3E%3Cli%3EReview, research and appeal partially denied claims for reconsideration.%3C/li%3E%3Cli%3EResponsible for contacting patients to gain additional information required to resolve outstanding insurance balances.%3C/li%3E%3Cli%3EFunction as resource person for departmental personnel to answer questions and assist with problem resolution.%3C/li%3E%3Cli%3EReview and resolve provider NPI/TPI claim edits rejections.%3C/li%3E%3Cli%3EReview and resolve provider NPI/TPI claim denial.%3C/li%3E%3Cli%3EAssist with working Claim Edit Work queues.%3C/li%3E%3Cli%3EAssist with working Team Lead Work queues.%3C/li%3E%3Cli%3EAssist with New Hire Training.%3C/li%3E%3Cli%3EPerforms other duties as assigned.%3C/li%3E%3C/ul%3E%3Cp%3E%3Cstrong%3ESECURITY AND EEO STATEMENT%3C/strong%3E%3Cbr%3E%3Cbr%3E%3Cstrong%3ESecurity%3C/strong%3E%3Cbr%3EThis position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.%3Cbr%3E%3Cbr%3E%3Cstrong%3EEEO%3C/strong%3E%3Cbr%3EUT 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.%3Cbr%3E%26nbsp;%3C/p%3E