UT Southwestern Medical Center · 1 month ago
Senior Reimbursement Specialist - Ophthalmology
Dallas, TX
Full-time
Hybrid
Senior Level
6+ years expUT Southwestern Medical Center is a world-renowned medical and research center in Dallas-Fort Worth, Texas. The Senior Reimbursement Specialist - Ophthalmology provides policy analysis and recommendations related to reimbursement projects, ensuring timely completion and appropriate implementation of changes.
Clinical TrialsHealth CareHospitalMedicalNon ProfitOncologyOutpatient Care
Responsibilities
Performs complex 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
Conducts meetings, organizes activities, reviews data analyses and reports, and creates reimbursement policies and procedures
Documents findings of inquiry and opinion letters. Maintains contract files, and files for research documents
Provides supervision to staff of lower grade in reimbursement operations
Performs other duties as assigned
Evaluates provider referral requirements and takes appropriate steps to ensure requirements are met prior to date of service. Tracks accounts to resolution
Effectively communicates with team members to ensure everything is correct, referral on file, estimates complete, etc., for upcoming dates of service
Coordinates ongoing pre-certification and approval process with carriers and provides clinical updates are requested
Address and resolve plan alerts/errors and insurance filing order discrepancies
Reviews clinical documentation for CPT/diagnosis code information to support authorizations according to carrier guidelines
Coordinates provider peer-to-peer appointments for applicable authorization denials
Communicates with physicians and other clinical staff regarding insurance benefits and financial status of patients
Counsels clinical staff and/or patients regarding benefit information when 'out of network' situations arise or other potential carrier concerns
Ensures that patients are aware of financial obligations, cost of care, access to financial education
Reviewing assigned work queues (insurance verification, procedure/surgery authorizations), DAR, and making recommendations for assignment changes
Ensuring projects relating to insurance verification/procedure authorizations are completed on time and changes are implemented appropriately
Writes applicable appeal letters for denied authorizations/pre-determinations
Assist patients sign up for copay assistance programs
Assist in the development and implementation of policies/SOPs
Contributes to the development of onboarding and training program for Reimbursement Specialists
Serves as the first line of escalation in the event of patient service failure
Demonstrates ongoing competency skills including above level problem solving skills and decision-making abilities
Provides supervision to staff of lower grade in insurance verification operations
Promotes team engagement
Maintains department productivity standards
Performs other duties as assigned
Qualification
Required
Education High School Diploma or GED
Experience 6 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
Benefits
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
Company
UT Southwestern Medical Center
UT Southwestern Medical Center offers clinical care, education, and scientific research.
10001+ employees
H1B Sponsorship
UT Southwestern Medical Center has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (358)
2024 (238)
2023 (266)
2022 (274)
2021 (213)
2020 (179)
Funding
Current Stage
Late StageTotal Funding
$22MKey Investors
The Dallas FoundationPatient-Centered Outcomes Research Institute
2023-06-20Grant
2023-04-20Grant· $4M
2023-03-28Grant· $18M
Leadership Team
Chris Rubio
Interim Chief Executive Officer, Clements University Hospital
Dennis Pfeifer
AVP & CTO University Health System
Recent News
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