[Hiring] Eligibility Denial Specialist II @UT Southwestern Medical Center

Role Description

This Eligibility Denial Specialist II position is responsible for researching any denied claim based on eligibility to ensure correct payers are billed timely on submitted insurance claims.

• Managing and resolving outstanding correspondence related to refund requests from insurance carriers.
• Reviewing refund requests, determining their validity, disputing questionable refunds, and communicating directly with insurance companies to resolve issues.
• Completing dispute letters, conducting follow-ups, and handling appeals to ensure proper resolution of refund issues.
• Requires strong attention to detail, the ability to effectively communicate with insurance carriers, and a solid understanding of billing and refund processes within the healthcare industry.

Work Arrangement: This is a work-from-home (WFH) position. Candidates must reside within the Greater Dallas-Fort Worth (DFW) area. Additional details will be discussed during the interview process.

Work Schedule: Flexible start time between 6:00 a.m. and 9:00 a.m., with an 8-hour workday, Monday through Friday.

Qualifications

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

Requirements

• Experience with reviewing and resolving refund request correspondence from various insurance carriers.
• Knowledge and experience with submitting dispute letters to insurance carriers and following up to track the status of refund disputes.
• Knowledge and experience in processing and issuing refunds in compliance with company policies, along with a strong understanding of insurance billing practices and regulations to resolve billing discrepancies.
• Ability to communicate effectively with insurance carriers via phone or written communication to resolve refund issues.
• Experience with online payer portals to manage refund requests and disputes.
• Knowledge of registration processes to resolve issues impacting patient or insurance account details related to refunds.
• Ability to multitask and prioritize tasks effectively while handling multiple refund disputes and requests.

Benefits

• 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.

Job Duties

• Review, research and resolve 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 all professional billing service areas.
• Updates registration and demographic information in all hospital billing service areas.
• Resolves eligibility denials in all clearinghouse and payer rejection WQ's.
• Review and resolve any Visit Filing order changes and work advanced Visit Filing Order WQ's.
• Function 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.

Knowledge, Skills and Abilities

• Ability to work in a fast-paced, production-oriented environment.
• Basic working knowledge of spreadsheet and word processing software.
• Knowledge of insurance billing and various types of health insurance.
• Strong oral and written communication skills, including the use of medical terminology.
• Strong organizational skills.
• Ability to analyze problems, develop solutions and implement new procedures.

Physical Requirements/Working Conditions

• Office Setting.

Salary Information

Salary is commensurate with education, skills, and relevant experience.

Security and EEO Statement

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. 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.