Insurance Claims Team Lead; Utrgv

Office Location
The University of Texas Rio Grande Valley
1201 W. University Drive
Human Resources
MASS Building 2 nd Floor
Edinburg, TX 78539

Edinburg:
Brownsville:
Office hours:
Monday-Friday
8:00a.m.

- 5:00p.m.

Faculty Recruitment:
College of Engineering & Computer Science: cecs

Robert

C. Vackar College of Business & Entrepreneurship: cobe

Dear Applicant, Human Resources will not be held responsible for redacting any confidential information from the documents you attach with your application. The confidential information includes the following:
* Date of Birth
* Social Security Number
* Gender
* Ethnicity/Race Please make sure that you omit this information prior to submission. We are advising that Human Resources will be forwarding your application to the department as per your submission. If you have any questions, please do not hesitate to contact us at  and/or careers.

Position Information

Posting Number

Posting Number SRGV
7151

Working Title

Number of Vacancies

Number of Vacancies 1

Location

Department

Department School of Medicine / Clinical Affairs

FTE

FTE 1.0

FLSA

FLSA Non-Exempt

Scope of Job

Oversees and coordinates the day-to-day operations of all third-party payers claims functions to include insurance follow-up and collection processes, denials, and rejections.

Description of Duties

• Supervises and coordinates the day-to-day activity for third-party payer claim functions to include follow-up processes, denials, and rejections (bill holds) activities to ensure UTRGV Health receives appropriate payments for services rendered.
• Ensures adherence to third party payer regulatory and legal guidelines, department policies and procedures.
• Monitors the denial management process to ensure that appropriate corrective actions are taken by billing specialists to obtain all reimbursement due to UT Health RGV .
• Works closely with billing specialists to ensure proper insurance follow-up, collections, and appeals are in compliance with UT Health RGV policies and procedures.
• Provides coaching and training to new hires and existing staff for the assigned area.
• Monitors rejections/denials (bill holds) workflow and directs work tasks as necessary to manage fluctuation volumes.
• Reviews and monitors Power BI dashboards to ensure account receivables follow-up/collections, denials (bill holds), and adjustments activities are meeting established productivity, quality, and reimbursement goals.
• Communicates regulatory changes to management and denials/insurance follow-up team promptly and effectively.
• Reviews, analyzes, and identifies denial trends to minimize financial losses and maximize opportunities to improve processes.
• Oversees approves and reconciles write-offs for adjustments as per policy and prepares manual adjustments as needed.
• Evaluates accounts to ensure that all third-party reimbursement options have been exhausted in resolving outstanding account balances.
• Reports on key quality, service, and coding productivity indicators on a regular basis to upper management.
• Maintains good communication with coders, providers, patient access team, and clinic team to ensure an effective working relationship.
• Works with leadership to develop and implement insurance follow-up and denial policies and procedures per Federal, State, and payer regulations and guidelines.
• Participates in hiring and evaluation of assigned staff.
• Stays abreast of current changes in billing, coding, and reimbursement requirements for government programs and other third-party payers.
• Performs other duties as assigned.

Supervision Received

General supervision from assigned supervisor.

Supervision Given

Direct supervision of assigned staff.

Required Education

• Associate Degree in Healthcare related field, or
• Two (2) years of the required experience in lieu of associate degree in addition to the required experience.

Preferred Education

N/A

Licenses/Certifications

N/A

Required Experience

Four (4) years of medical, hospital, or healthcare revenue cycle related experience, including thorough knowledge of registration, scheduling, pre-certification, prior authorization, coding, claims billing and insurance follow-up, payer reimbursement, posting, and collections processes.

Preferred Experience

Previous supervisory and coding experience. Bilingual (English/Spanish).

Equipment

Use of standard office equipment. Proficient use of computers and working knowledge of Microsoft Office – Excel, Word, Power Point

Working Conditions

Needs to be able to successfully perform all required…