Technical Denials Management Specialist III

Job Title : Technical Denials Management Specialist III Job Code : 7006 Location : Texas, Dallas – 5323 Harry Hines Blvd (Greater DFW area, work‑from‑home) Shift : 8‑hour days, Monday through Friday. Job Summary UT Southwestern Medical Center has an opening within the Revenue Cycle Department team for a Technical Denials Management Specialist III. The role is responsible for billing applicable payers and ensuring timely collections of various insurance claims; it will review, research and appeal complex denials and inadequate payments from third‑party payers while identifying trends of payment problems to maximize collections. This position is an excellent opportunity for professionals with a background in medical claims, appeals, and payer communications. Essential Functions Contact payers via website, phone and/or correspondence regarding reimbursement of unpaid accounts over 30 days, and research and follow up on denials and requests 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. Contact patients to obtain additional information required to resolve outstanding insurance balances. Act as a resource person for departmental personnel to answer questions and assist with problem resolution. Review and resolve provider NPI/TPI claim edits and rejections. Review and resolve provider NPI/TPI claim denials. Assist with Claim Edit work queues. Assist with Team Lead work queues. Assist with new hire training. Perform other duties as assigned. Qualifications Education and Experience High School Diploma or Associate's Degree required. 4 years of experience in medical claims recovery and/or collections with a High School Diploma, or 2 years of experience in medical claims recovery and/or collections within a healthcare or insurance environment with an Associate's Degree preferred. Knowledge, Skills and Abilities Self‑starter who can work well as part of a team and independently. Effective communication with patients, insurance companies, clinical staff and management. Ability to handle large volumes of work. Ability to work in a fast‑paced, production‑oriented environment. Excellent customer service skills. Experience in medical billing, accounts receivables, and/or collections within a healthcare or insurance environment. Good organizational, flexibility and analytical skills when resolving complex unpaid claims. Knowledge of CMS 1500, ICD‑10, and CPT coding is preferred. Strong work ethic, commitment to job responsibilities, and a positive image that reflects well on the organization. Professional and courteous demeanor while being assertive and confident in collection efforts. Strong written and verbal communication skills. Understanding of the requirements of Medicaid, Medicare and insurance billing. Physical Demands / Working Conditions Physical Demands: Talking Working Conditions: Office setting Salary Salary Negotiable. 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. #J-18808-Ljbffr UT Southwestern Medical Center