Role OverviewUT Southwestern Medical Center seeks a Technical Denials Management Specialist III to review, research, and resolve claim denials and appeals for various insurance companies while identifying payment trends to maximize collections. The ideal candidate is well-versed in working with EPIC Resolute. This is a work-from-home position with a flexible start time.
What You Will Do
The Technical Denials Management Specialist III will review, research, and appeal partially denied claims for reconsideration, contact payers to gain additional information required to resolve outstanding insurance balances, and function as a resource person for departmental personnel to answer questions and assist with problem resolution.
Why It Might Be a Fit
The ideal candidate is well-versed in working with EPIC Resolute, has experience with Reconsideration, Redetermination, and Appeal with health insurance carriers, and has strong critical thinking, problem-solving, and decision-making skills.
Requirements
- Experience with Reconsideration, Redetermination, and Appeal with health insurance carriers
- Knowledge and experience with handling and resolving NCCI edits, LCD/NDC, and bundling denials
- Knowledge and experience with denial codes from the remittance/EOB
- Ability to read and understand Explanation of Benefits
- Ability to multitask and prioritize competing assignments
- Experience contacting insurance companies and patients
- Knowledge and experience with online payer portals
- Epic experience
- Experience with reviewing medical records
- Advanced experience researching and resolving complex or escalated professional billing claims and denials
- Experience monitoring work queues, aging inventory, productivity, and workflow priorities
- Experience training staff and explaining processes, payer requirements, and resolution steps
- Ability to analyze denial trends, identify root causes, and recommend process improvements
- Ability to lead workflow activities and assist with quality review and operational follow-up
Benefits
- PPO medical plan
- 100% coverage for preventive healthcare-no copay
- Paid Time Off
- 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
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