Eligibility Denial Specialist II MSP

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 a crucial member of our team, responsible for reviewing and resolving outstanding claims within the revenue cycle process. This role involves a comprehensive understanding of billing procedures, insurance protocols, and revenue cycle management software, particularly Epic. The primary duties include investigating and resolving claims held in the Epic Work queue (WQ), through methods such as calling insurance companies, appealing claims, and analyzing Epic WQ rules and logic.

This position also entails identifying the root cause of claims being held in the WQ and collaborating with the IR department to establish or update routing rules within the system. Furthermore, the incumbent will provide insights and guidance to leadership on strategies to prevent future claims from falling into the WQ, thereby optimizing revenue flow.

Eligibility Denial Specialist II will play a pivotal role in resolving issues; therefore, a strong understanding of registration, follow-up, coding, and Epic systems are essential. The ideal candidate will demonstrate adaptability, a quick learning aptitude, and a strong work ethic to effectively fulfill the responsibilities of this role.

• Work independently and as part of a team to meet goals and deadlines.
• Maintain focus and productivity with minimal supervision.
• Communicate clearly with colleagues and management to ensure successful outcomes.
• Take responsibility for tasks, ensuring reliability and accountability.
• Adapt to changing priorities while maintaining quality and efficiency.
• Resolve outstanding medical insurance claims.
• Familiar with Epic Follow-up WQ logic and routing rules.
• Collaborate with Information Resources on IR tickets and routing logic.
• Manage Reconsiderations, Redeterminations, and Appeals with insurance carriers.
• Address NCCI edits, LCD/NCD, and bundling denials.
• Understand denial codes from remittance/EOBs.

Our Culture:

Our teams' 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.

Shift: 8-hour flex shift, Monday through Friday 

Work From Home (WFH): This is a work from home opportunity. Applicants must live within the Greater DFW area. Additional details to be discussed as part of the interview process. 

Work From Home WFH): This position will be a work from home job. Additional details related to this shall 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% 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 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.