Eligibility Denial Specialist II at UT Southwestern Medical Center

United States

WHY UT SOUTHWESTERN? 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! JOB SUMMARY This job is responsible for researching any denied claim based on eligibility to ensure correct payers are billed timely on submitted insurance claims. The Eligibility Denial Specialist II is responsible for the timely and accurate resolution of medical claims denied under No Surprise Billing regulations and for performing follow-up on claims with non-contracted payers. This role involves analyzing denied claims, addressing issues with both contracted and non-contracted payers, and working closely with insurance companies to ensure compliance with the No Surprises Act. The specialist will play a key role in minimizing financial losses while maintaining strong relationships with insurance payers and ensuring an optimal revenue cycle process. Our Culture: Our team’s culture is Love based, which thrives on mutual respect, empathy, and support, fostering an environment where every member feels valued and empowered. It prioritizes open communication, collaboration, and understanding, creating a cohesive and inclusive community where individuals can flourish personally and professionally. Claims Follow-Up: Review and analyze denied claims specifically related to No Surprise Billing regulations. Liaise with insurance companies, including non-contracted payers, to resolve denied claims, escalate issues when needed, and ensure timely payment. Ensure compliance with the No Surprises Act, stay informed about any regulatory changes that impact on billing practices. Identify denial patterns related to No Surprise Billing and communicate trends to management for potential workflow improvements. Skilled in Reconsideration, Redetermination, and Appeals with health insurance carriers. Excellent written and verbal communication for interacting with insurance companies, colleagues, and supervisors. Capable of working independently or collaboratively within a team to meet production goals. Shift: 8-hour flex shift, Monday through Friday Work From Home (WFH): This is a work from home opportunity currently. Applicants must live within the Greater DFW area. Additional details are to 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%25 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! EXPERIENCE AND EDUCATION Required Education High School Diploma or equivalent. Experience 4 years medical billing, claims processing, and/or insurance eligibility experience. May consider medical billing certifications or graduate degrees in lieu of experience. 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. SECURITY AND EEO STATEMENT 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.