Technical Denials Management Specialist III

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!

UT Southwestern Medical Center has a new opportunity available in the Revenue Cycle Department for the role of Technical Denials management Specialist II. You will 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.

• Shift: Flex start , 8-hour shift
• Work From Home (WFH):
  This is a WFH position. Applicants must live within the Greater Dallas-Fort Worth (DFW) area.

The team 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. Love Based cultivates a culture where kindness, compassion, and appreciation are foundational principles, leading to greater creativity, productivity, and fulfillment for all team members.

• Work both independently and collaboratively within a team to achieve production goals and deadlines.
• Demonstrate a strong commitment to productivity by staying focused and on task without constant supervision.
• Effectively communicate with colleagues, supervisors, and manager to ensure clarity, alignment, and successful outcomes.
• Take ownership of assigned tasks and projects, demonstrating accountability and reliability in meeting expectations.
• Adapt to changing priorities and work demands while maintaining a high level of quality and efficiency.
• Proactively identify opportunities for process improvement and contribute innovative solutions to enhance overall productivity and teamwork.
• Ability to contact medical insurance payers and resolve outstanding claims.
• Ability to appeal denied claims and pursue appropriate action to overturn denials.
• Serve as a team lead by providing day-to-day guidance, support, and direction to team members.
• Handle complex, high-priority, or escalated accounts and work items that require advanced research and resolution.
• Train and mentor new and existing team members on workflows, payer requirements, Epic processes, and departmental procedures.
• Lead team workflow activities, help prioritize assignments, monitor inventory, and support completion of production goals and deadlines.
• Assist the supervisor with operational needs, team communication, issue resolution, and follow-up on assigned initiatives.
• Identify and elevate trends, barriers, or risks that may affect quality, productivity, reimbursement, or timely claim resolution.
• Support quality assurance, process standardization, and continuous improvement efforts across the team.

• 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.
• Knowledge and experience with contacting health insurance carriers.
• 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…