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

Role Description

The Eligibility Denial Specialist III is responsible for researching any denied claim for both professional and hospital billing based on eligibility to ensure correct payers are billed timely on submitted insurance claims.

• Manage and resolve outstanding correspondence related to refund requests from insurance carriers.
• Review refund requests, determine their validity, dispute questionable refunds, and communicate directly with insurance companies to resolve issues.
• Complete dispute letters, conduct follow-ups, and handle appeals to ensure proper resolution of refund issues.
• Serve as a team lead, handle complex and escalated refund matters, train and mentor staff, lead workflow activities, and assist the supervisor with operational needs and team support.
• Shift - 8 hour days, Monday through Friday. Flex starts between 0600-0900.
• Work from home (WFH) - The candidate will work from home and must live within the Greater Dallas-Fort Worth (DFW) area.

Qualifications

• 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.
• Ability to communicate effectively with insurance carriers via phone or written communication.
• 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.
• Advanced experience researching and resolving complex or escalated refund requests, disputes, and appeals.
• Experience monitoring work queues, correspondence inventory, aging, productivity, and workflow priorities.
• Experience training staff and explaining refund processes, payer requirements, dispute documentation, and resolution steps.
• Ability to analyze refund trends, identify root causes, and recommend process improvements.
• Ability to lead workflow activities and assist with quality review and operational follow-up.

Requirements

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

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.