Technical Denials Management Specialist III

THE UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER

JOB INFORMATION

Job Code: 7006

Job Title:

TECHNL DENIALS MGMT SPEC III

Date Last Edited: 8/22/2025

FLSA Status: N

JOB SUMMARY

UT Southwestern Medical Center has an opening within the Revenue Cycle Department team for a Technical Denials Management Specialist III. Responsible for billing applicable payers and ensuring timely collections of various insurance claims; will review, research, and appeal complex denials and inadequate payments from third-party payers while identifying trends of payment problems in an effort to maximize collections. This position is an excellent opportunity for professionals with a background in medical claims, appeals, and payer communications.

Thid ideal candidate will demonstrate expertise in analyzing the following
- * Explanation of Benefits (EOBs)

* Resolving claim denials

* Managing appeals

* Ensuring time reimbursement

This is a work-from-home (role); however, the selected candidate must reside in the Greater DFW area and be available for occasional onsite visits for training, equipment pickup, and meetings.

Shift: 8-hour days, Monday through Friday

ESSENTIAL FUNCTIONS

Job Duties

* Contact payers, via website, phone and/or correspondence, regarding reimbursement of unpaid accounts over thirty (30) days or more, also researching and following up on denials and request for additional information.

* Interpret Manage Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection.

* Make necessary adjustments as required by plan reimbursement.

* Perform payment validation by utilizing internal and/or external resources to ensure proper reimbursement.

* Review, research and appeal partially denied claims for reconsideration.

* Responsible for contacting patients to gain additional information required to resolve outstanding insurance balances.

* Function as resource person for departmental personnel to answer questions and assist with problem resolution.

* Review and resolve provider NPI/TPI claim edits rejections.

* Review and resolve provider NPI/TPI claim denial.

* Assist with working Claim Edit Work queues.

* Assist with working Team Lead Work queues.

* Assist with New Hire Training.

* Performs other duties as assigned.

QUALIFICATIONS

Education and Experience

Required

* Education

High School Diploma or

Associate's Degree

* Experience

4 years experience in medical claims recovery and/or collections with High School Diploma. or

2 years experience in medical claims recovery and/or collections within a healthcare or insurance environment is preferred with Associates Degree.

Knowledge,

Skills and Abilities

* Work requires a self-starter, with ability to work well as part of a team and independently.

* Work requires ability to communicate effectively with patients, insurance companies, clinical staff and management.

* Work requires ability to handle large volumes of work.

* Work requires ability to work in a fast paced, production-oriented environment.

* Work requires excellent customer service skills.

* Work requires experience in Medical Billing, Accounts Receivables, and/or Collections within a healthcare or insurance environment.

* Work requires good organizational, flexibility and analytical skills when resolving more complex unpaid claims.

* Work requires knowledge of CMS 1500, ICD-10, and CPT coding is preferred.

* Work requires one to exhibit excellent work ethics and commitment to job responsibilities. Work requires presence of a positive image that reflects well on the organization.

* Work requires one to possess a professional and courteous demeanor while being assertive and confident in their collection efforts.

* Work requires strong written and verbal communication skills.

* Work requires understanding of the requirements of Medicaid, Medicare and insurance billing.

PHYSICAL DEMANDS/WORKING CONDITIONS

* Physical Demands

Talking

* Working Conditions

Office Setting

Salary

Salary Negotiable

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 Statement

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.