Reimbursement Specialist - Ophthalmology Billing/Follow-Up

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
Works under moderate supervision to provide policy analysis and recommendations to management related to reimbursement projects and functions.

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!

Candidate must live in Dallas, Fort Worth metroplex

Work Shift: Monday-Friday

EXPERIENCE AND EDUCATION
Required

• EducationHigh School Diploma or equivalent
• Experience4 years of progressively responsible experience in medical insurance, medical billing or medical reimbursement.

Preferred

• Licenses and Certifications(CPC) CERT PROFESSIONAL CODER Upon Hire orAdvanced Records Technician (ART) Upon Hire or(RRA) REGISTERED RECORDS ADMIN Upon Hire

Job Duties

 Ophthalmology Department Job Duties

• Performs insurance verification/eligibility and coordinates precertification/referrals on all applicable patient accounts.
• Identifies and verifies essential information pertaining to guarantor/subscriber.
• Export DAR (Daily Appointment Report) from applicable Epic (Parkland, JPS, CMC) to review accounts that require verification, referrals, and/or authorization.
• Verifies patient insurance benefits and eligibility for all applicable scheduled services specific to the type of appointment, procedure and/or exam, and site of service via carrier websites or calling insurance companies
• Address and resolve plan alerts/errors and insurance filing order discrepancies
• Insurance denial follow-up
• Working insurance follow-up work queues
• Unpaid claims
• Submitting corrected claims
• Reviews clinical documentation for CPT/diagnosis code information to support authorizations according to carrier guidelines
• Working credits for patients and insurance
• Charge Review/Entry
• Analyzes, investigates and resolves coding edits for E&M services, diagnostic studies, and minor surgical procedures. This includes CPT, diagnosis, modifier, bundling, duplicate charge, and custom edit resolution.  Requires knowledge of the carrier’s (Federal/State/Private) regulations and guidelines, internal revenue cycle coding processes and be familiar with the billing practices of the specialty service line.  This position requires a high degree of organization and accuracy and requires clear communication with providers on a regular basis to insure visits are well documented and meet all billing requirements.
• Performs limited abstracting on E&M services, diagnostic studies, and moderate to minor surgical procedures.   Requires the ability to read the progress note and or procedure results and confirm or change the CPT code(s), diagnosis code(s) and modifiers (if applicable).  Requires knowledge of the carrier coverage policies and be familiar with the billing practices of the specialty service line.  Must be familiar with the Medicare and Medicaid teaching physician documentation billing rules.
• Performs monthly charge reconciliation.
• Investigates and resolves coding and registration Epic Resolute Claim edits.  Requires strong knowledge of Epic’s carrier registration filing order rules and billing rules.
• Performs manual charge entry for all non-EpicCare and non-automated sites of services.  This includes E&M visits and procedures. 
• May assist in adding insurance authorizations to the claim and accurately maintaining the authorization records, communicate patient balance and patient-responsibility amounts to clinics and/or patient/families, responding to requests for information. 
• Attend coding and billing in-services to stay current on changes; attend other meetings and training as assigned.
• Familiar with EPIC, PDF, Waystar, and other payor portals
• Documents pertinent information in system based upon department documentation standards (Epic Guarantor Account Notes).
• Assists with training new teammates.
• Interacting and communicating effectively with staff, patients, and providers.
• Query providers when needed regarding documentation.
• Must be able to work independently or within a group dynamic.
• The use of initiative, strong independent judgement, and resourcefulness are inherent in the job.
• Maintains department productivity standards.
• Performs other related duties and projects 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.