This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information
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.
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 payer's 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.
UTSouthwestern 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 UTSouthwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.