Reimbursement Specialist

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 The Department of Revenue Cycle – Ambulatory Patient Financial Services has an exciting opportunity to support the Ophthalmology and Optometry department. This role works under moderate supervision to provide policy analysis and recommendations to management related to reimbursement projects and functions and is responsible for initiating insurance verification and precertification processes, while providing financial counseling and clearance services to patients. Key Responsibilities: Work effectively in a fast-paced environment while demonstrating strong time management skills. Manage multiple tasks and priorities simultaneously. Maintain clear, accurate, and concise documentation. Demonstrate an understanding of insurance plans and coverage requirements. Review and interpret payer medical necessity criteria, policies, and guidelines. Apply billing and coding guidelines accurately. Verify patient insurance eligibility and benefits. Review insurance benefits to ensure both the organization and the patient understand the extent of coverage for services. Obtain required insurance referrals and authorizations. Utilize critical thinking and problem-solving skills to resolve issues efficiently. Distinguish between medical and routine services to ensure proper processing and coverage determination. Additional Information: This is a remote/work-from-home position. Candidates must reside in Texas; Dallas-Fort Worth (DFW) area preferred. Schedule: Monday through Friday, 7:30 a.m. – 4:30 p.m. Additional details will be discussed during 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%25 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 of progressively responsible experience in medical insurance, medical billing or medical reimbursement. Preferred Licenses and Certifications (CPC) CERT PROFESSIONAL CODER Upon Hire or Advanced Records Technician (ART) Upon Hire or (RRA) REGISTERED RECORDS ADMIN Upon Hire JOB DUTIES Performs policy analysis for managed care issues by reviewing contracts, writing clause revisions, making recommendations for reimbursement policy changes, reviewing reports and financial data, and analyzing fee schedules, encounter forms, diagnosis, and procedure codes; ensures contracts reflect appropriate business decisions. Ensures projects related to reimbursement issues are completed on time and changes are implemented appropriately by conducting meetings, organizing activities, reviewing data analyses and reports, and creating reimbursement policies and procedures. Documents findings by writing inquiry letters, constructing opinion letters, maintaining contract files, and maintaining files for research documents. 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 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.