MSRDP Technical Denials Management Specialist II - Medicine and Ancillary Services 9/1/2016

UT Soutwestern University Medical Center Dallas, TX

Company
UT Soutwestern University Medical Center
Job Classification
Full Time
Company Ref #
524288
AJE Ref #
576054224
Location
Dallas, TX
Experience
Mid-Career (2 - 15 years)
Job Type
Regular
Education
High School Diploma or GED

JOB DESCRIPTION

Full/Part Time/PRN: Full-Time
Regular/Temporary: Regular



















Security
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This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information





Salary
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Salary Negotiable





Experience and Education
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High School Diploma and two (2) years experience in medical claims recovery and/or collections rules and regulations required.









Job Duties
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1. Contacting 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 requests for additional information.
2. Interpret Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection.
3. Make necessary adjustments as required by plan reimbursement.
4. Performs payment validation by utilizing internal and/or external resources to ensure proper reimbursement.
5. Reviews, research and appeal partially denied claims for reconsideration.
6. Responsible for contacting patients to gain additional information required to resolve an outstanding insurance balance.
7. Functions as resource person for departmental personnel to answer questions and assists with problem resolution.

Performs other duties as assigned.



To the extent provided by applicable law, no person shall be excluded from participation in, denied the benefits of, or be subject to discrimination under any program or activity sponsored or conducted by The University of Texas System or any of its component institutions, on the basis of race, color, national origin, religion, sex, sexual orientation, age, veteran status, or disability..