Claims Edit Specialist I MSRDP - Revenue Cycle

Location

Type, TX | United States

Job description

JOB SUMMARY: 

UT Southwestern Medical Center, Department of Revenue Cycle has a new employment opportunity available for the role of  Claims Edit Specialist I. This job is responsible for reviewing and processing basic insurance claim edits in a timely manner under direct supervision of supervisor.

• Work From Home (WFH): This is a WFH position. Candidates must live within the Greater DFW area. Additional detail shall be discussed as part of the interview process.
• Shift: 8 hour days, flex shift beginning from 0600-0900

Team 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. Love Based cultivates a culture where kindness, compassion, and appreciation are foundational principles, leading to greater creativity, productivity, and fulfillment for all team members

The ideal candidate expectations and duties will include but not be limited to the following:

• Work both independently and collaboratively within a team to achieve production goals and deadlines.
• Demonstrate a strong commitment to productivity by staying focused and on task without constant supervision.
• Effectively communicate with colleagues, supervisors, and manager to ensure clarity, alignment, and successful outcomes.
• Take ownership of assigned tasks and projects, demonstrating accountability and reliability in meeting expectations.
• Adapt to changing priorities and work demands while maintaining a high level of quality and efficiency.
• Proactively identify opportunities for process improvement and contribute innovative solutions to enhance overall productivity and teamwork

Hard Skills

• Epic experience
• Knowledge and experience with registration
• Knowledge and experience with health insurance carriers
• Ability to read and understand Explanation of Benefits
• Ability to multitask
• Contacting insurance companies and patients

Soft Skills

• Outlook experience
• Team experience
• Excel experience
• Medical Terminology

EXPERIENCE / EDUCATION: 

REQUIRED:

• High school diploma or equivalent and two (2) years’ experience with medical billing or claims processing, knowledge of billing and/or collections rules and regulations is required.  
• May consider education in lieu of experience.

JOB DUTIES:

• This job is responsible for reviewing and processing basic insurance claim edits in a timely manner under direct supervision of supervisor. 
• Reviews and processes basic insurance claim edits through the billing system for registration and demographic accuracy.
• Utilizes vendor and third party websites for eligibility and benefit verification, including update of registration information within the billing system.
• Reposts and resubmits claims based on research findings and billing system updates. Works in all professional billing service areas.
• Updates registration and demographic information in at least two hospital billing service areas.
• Escalates issues above knowledge base to higher level specialist or supervisor.
• 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.  

KNOWLEDGE, SKILLS & ABILITIES: 

• Work requires ability to work in a fast paced, production oriented environment.
• Work requires knowledge of insurance billing and various types of health insurance.
• Work requires strong organizational skills Work requires good oral and written communication skills, including the use of medical terminology.
• Work requires Basic working knowledge of spreadsheet and word processing software.    

WORKING CONDITIONS: 

Work is performed primarily in a general office environment.

SECURITY:

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

UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; sex; including sexual harassment; age; disability; genetic information; citizenship status; and protected veteran status. In addition, it is UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression. 

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