Job description

Experience and Education

Minimum 5 years hospital or medical billing experience.

High School Diploma. Bachelors preferred.

Knowledge of health insurance mechanisms and coverage is required. Effective oral and written communications skills (including grammar). Proficient keyboarding, accuracy and math aptitude skills.

Competencies: all payer classes

Job Duties

1. Analyze payer underpayments, variances, and denials. Escalate trends, make comprehensive suggestions, and file professional appeals according to our contractual agreements and UT Southwestern policy. This includes timely processing of allocated volume of accounts, based on established production guidelines and time parameters provided for workflow.

2. Responsible for outbound calls and/or status inquiries via payers website validating receipt of medical claims and adjudication status within established timeframes. Display competent ability to access, navigate, and manage account information through phone calls and payer websites. Documents all work and calls performed, in accordance to policy. This includes complete contact information, good grammar, and expected outcomes.

3. Display competency and ability to work within client based, research, and UTSW special arrangements. This includes, but is not limited to: calculating the physician and hospital share and working with MSP to transfer the physician\'s share to that department, working with other departments at UTSW to properly invoice clients and bill claims for proper adjudication per our agreements.

4. Be knowledgeable on all payer types and effectively work on special projects for specific initiatives for account resolution projects. Demonstrate confidence and sound decision making for processing through large volumes of denials, complex accounts, or contractual reviews, as identified from strategic leadership requirements.

5. Make necessary adjustments as required by plan reimbursement.

6. Function as a departmental liaison for billing and collections support for internal and external customers, as required.

**Other Duties: Performs other duties as assigned.

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 #1 hospital in Dallas-Fort Worth for the fifth consecutive year, we invite you to continue your healthcare career with us at William P. Clements Jr. University Hospital. You’ll discover a culture of teamwork, professionalism, and consistent opportunities for learning and advancement into leadership roles.

Compliance with the COVID-19 vaccine mandate enforced by the Centers for Medicare and Medicaid (CMS) is a requirement for this position. Federal law requires individuals holding this position to be fully vaccinated or have an approved exemption for certain medical, disability, or religious reasons. Individuals who do not meet CMS vaccination requirements are not eligible and should not apply for this position but are encouraged to apply for other non-healthcare positions at UT Southwestern for which they qualify.

For COVID-19 vaccine information, applicants should visit https://www.utsouthwestern.edu/covid-19/work-on-campus/

To learn more about the benefits UT Southwestern offers, visit https://www.utsouthwestern.edu/employees/hr-resources/

This position is security-sensitive and subject to Texas Education Code §51.215, which authorizes UT Southwestern to obtain criminal history record information. UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; sex; including sexual harassment; age; disability; genetic information; citizenship status; and protected veteran status. In addition, it is UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.

Security

This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information

Salary

Salary Negotiable

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