Eligibility Denial Specialist I

Eligibility Denial Specialist I

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!

The Department of Revenue Cycle at UT Southwestern Medical Center has a new employment opportunity available for the role of Eligibility Denial Specialist I MSP. This position is responsible for researching basic denied claims based on eligibility to ensure correct payers are billed timely on submitted insurance claims. The duties for this position will consist of but are not limited to the following:

• Maintain regular phone communication with patients and insurance companies
• Verifying insurance
• Updating registration
• Working high volume denial inventory
• One on one training along with detailed tip sheets
• Experience with Parkland Charity processes is preferred

Shift: Flex-shift from 0600-5:00pm, 8-hours per day

Work From Home (WFH): This is a work from home position. Applicants must live within the Greater DFW area. Additional details related to this will be discussed as part of the interview process

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!

Required Education High School Diploma or equivalent and Experience 2 years of medical billing, claims processing, and/or insurance eligibility May consider medical billing certifications or graduate degrees in lieu of experience.

Job Duties Review, research and resolve basic 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 up to two professional billing service areas. Updates registration and demographic information in at least two hospital billing service areas. Review and resolve any Visit Filing order changes. Functions 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.

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.