Hospital Technical Claims Collector

• Work from home (WFH): This is a WFH opportunity. Candidates must live in Texas, DFW area preferred. Additional details shall be discussed as part of the interview process.
• Shift: Flex, 8-hour shift Monday through Friday. Shift begins from 0600-0830.

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!

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!

JOB SUMMARY:

The Hospital Technical Denials Claims Collector is responsible for analyzing payer underpayments, variances, and claim denials. This role requires identifying trends, escalating issues, and providing well-documented appeals in alignment with contractual agreements and UT Southwestern policies. The collector ensures timely processing of assigned accounts by adhering to established production guidelines and workflow requirements.

Key Responsibilities and Expectations:

• Investigate and resolve denied claims by reviewing payer policies, agreements, and reimbursement structures.
• Conduct outbound calls and utilize payer websites to validate claim receipt and adjudication status within required timeframes.
• Maintain detailed and accurate documentation of all account activities, including calls, correspondence, and appeal outcomes.
• Collaborate with internal departments, including physician billing teams and client-based research teams, to ensure proper claim invoicing and resolution.
• Stay informed on payer policies and reimbursement models for all payer types, participating in special projects and strategic initiatives as needed.
• Apply appropriate adjustments based on plan reimbursement requirements.
• Prepare and submit appeals to insurance companies to overturn denials, providing necessary documentation and justification.
• Correct errors and resubmit claims to insurance companies after resolving denial issues.
• Contribute to the overall efficiency of the revenue cycle by identifying and addressing issues that lead to denials and underpayments.
• Adapt to changing priorities and work demands while maintaining a high level of quality and efficiency.
• Demonstrate a strong commitment to productivity by staying focused and on task without constant supervision.

SKILLS and Qualifications:

• Work both independently and collaboratively within a team to achieve production goals and deadlines.
• Familiarity with medical billing procedures, coding systems (e.g., ICD-10, CPT), and payer guidelines.
• Knowledge of various insurance plans, their policies, and claim processing requirements.
• Effectively communicate with colleagues and Supervisor to ensure clarity, alignment, and successful outcomes.
• Take ownership of assigned tasks and projects, demonstrating accountability and reliability in meeting expectations.
• Prior experience in working with hospital claim denials and appeals is required.
• Ability to appeal denied claims and overturn the denial when it is determined that payment is due.
• Experience working with 835 files in addition to paper and/or electronic EOB's.
• Knowledge and experience with handling and resolving NCCI edits, LCD/NCD issues, and bundling denials.
• Attention to detail
• Ability to read and understand all communication received from an insurance carrier. This will include EOB's, denial letters, audit letters, and other request letters.
• Knowledge and experience using payer portals (i.e. Availity, Evicore, etc.)
• Experience with reviewing medical records and itemized bills.
• Experience using electronic medical record (EMR) systems and billing software such as Epic.
• Strong investigative and problem resolution skills.
• Microsoft Office software experience
• Ability to read and interpret medical procedures and terminology

EXPERIENCE AND EDUCATION
Required

• Education
  High School Diploma

• Experience
  5 years hospital or medical billing experience

Preferred

• Education
  Bachelor's Degree

JOB DUTIES

• Analyze payer underpayments, variances, and denials. Escalate trends, make comprehensive suggestions, and file professional appeals according to our contractual agreements and UT Southwestern policy. This includes timely processing of allocated volume of accounts, based on established production guidelines and time parameters provided for workflow.
• Responsible for outbound calls and/or status inquiries via payer's website validating receipt of medical claims and adjudication status within established timeframes. Display competent ability to access, navigate, and manage account information through phone calls and payer websites. Documents all work and calls performed, in accordance to policy. This includes complete contact information, good grammar, and expected outcomes.
• Display competency and ability to work within client based, research, and UTSW special arrangements. This includes but is not limited to calculating the physician and hospital share and working with MSP to transfer the physician's share to that department, working with other departments at UTSW to properly invoice clients and bill claims for proper adjudication per our agreements.
• Be knowledgeable on all payer types and effectively work on special projects for specific initiatives for account resolution projects. Demonstrate confidence and sound decision making for processing through large volumes of denials, complex accounts, or contractual reviews, as identified from strategic leadership requirements.
• Make necessary adjustments as required by plan reimbursement.
• Function as a departmental liaison for billing and collections support for internal and external customers, as required.
• Utilize systems tools and department resources to achieve production and quality targets for resolution of patient accounts.
• Investigates and responds to questions or requests for additional information in a timely and professional manner to ensure proper, timely and accurate payment of patient accounts.
• Maintains passing QA Scores
• Attends in-services, classes and meetings related to all operations to the PFS department. Understands reimbursement of all 3rd party payers.

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.

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!