Claims Edit Specialist II

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%27ll discover a culture of teamwork, professionalism, and a rewarding career! JOB SUMMARY This job is responsible for reviewing and processing basic and complex insurance claim edits in a timely manner under direct supervision of supervisor. Shift - 8-hour, flex shift Monday through Friday Work From Home: Although this is a WFH position, the applicant must live in the Greater DFW area. Our 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 Job Expectations: 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 managers 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 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! EXPERIENCE AND EDUCATION Required Education High School Diploma Or equivalent Experience 4 years%27 Experience with medical billing or claims processing, knowledge of billing and/or collections rules and regulations and May consider education in lieu of experience JOB DUTIES Reviews and processes basic and complex insurance claim edits through the billing system. Utilizes vendor and third-party websites for eligibility/benefit verification and authorization information. Updates the billing system accordingly. 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. Assists lower-level specialists. May escalate 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. 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. 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%27ll discover a culture of teamwork, professionalism, and a rewarding career! JOB SUMMARY This job is responsible for reviewing and processing basic and complex insurance claim edits in a timely manner under direct supervision of supervisor. Shift - 8-hour, flex shift Monday through Friday Work From Home: Although this is a WFH position, the applicant must live in the Greater DFW area. Our 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 Job Expectations: 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 managers 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 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! EXPERIENCE AND EDUCATION Required Education High School Diploma Or equivalent Experience 4 years%27 Experience with medical billing or claims processing, knowledge of billing and/or collections rules and regulations and May consider education in lieu of experience JOB DUTIES Reviews and processes basic and complex insurance claim edits through the billing system. Utilizes vendor and third-party websites for eligibility/benefit verification and authorization information. Updates the billing system accordingly. 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. Assists lower-level specialists. May escalate 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. 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.

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