Manager, Hospital Denials

University of Texas Southwestern Medical Center
parental leave, paid time off, paid holidays, tuition reimbursement, remote work
United States, Texas, Dallas
5323 Harry Hines Boulevard (Show on map)
Jan 05, 2025
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 Manager of PFS Revenue Cycle Operations AKA Hospital Denials Manager, plays a pivotal role in the hospital's revenue cycle by overseeing and optimizing the resolution of technical insurance claim denials and insurance follow-up. This position manages three Supervisors and a team of 35 staff members, ensuring efficient workflows, staff engagement, and adherence to best practices in denials management. The Manager is responsible for identifying root causes of technical denials, developing strategies to prevent future occurrences, and driving initiatives that reduce accounts receivable balances and improve cash flow. Some of the key responsibilities include the following: Leadership and Team Management Tehnical Denials Management Operations Oversight Technology and Innovation Stakeholder Collaboration Previous EPIC Resolute experience Work From Home (WFH): This is a WFH position. Applicant must live in Texas, the Greater DFW area is preferred. Additional details shall be discussed as part of the interview process. Shift: 8am-5pm, Monday through Friday 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 Experience 5 years of hospital billing / operations to include federal, state, third party payors, research & transplant. 3 years of progressive supervisory / management experience with extensive knowledge of Patient of Financial systems & processes including the healthcare revenue cycle, coding & billing compliance. Proven record of identifying PI opportunities. Requires strong negotiating, analytical & organizational skills as well as the ability to be flexible with changing needs & deadlines; the ability to interact & communicate both verbally & in writing with all levels of associates, mgmt & patients. JOB DUTIES Demonstrate continuous performance improvement in targeted areas of responsibility in alignment with the overall annual Hospital performance improvement targets. a) Manages daily operation of all Hospital Billing to ensure all charges are processed and billed in a timely manner to include Federal, State, and Third Party Payors. (Billing and Collections of all Federal/State Payors i.e. Medicare/Medicaid). Responsible for daily exporting of claims from billing system to claim editor. Daily reconciliation between systems. b) Manages research and client billing & collections. Maintaining appropriate fee schedules. c) Manages billing/collection of Solid Organ & BMT services to include acquisition, pre/post transplant. Manages Special Billing protocols to include package plans, self pay, intl. patient billing, purchased services, workers comp & occupational billing, & other clinical departments, etc. Maintains appropriate fee schedules. Coordinates all workflow issues and accounts concerns with Supervisors, peers, and leadership. Ability to properly delegate and prioritize work demands to meet or exceed financial goals and objectives of the department. This includes monitoring quality and quantity of work, performing Quality Reviews (QA's). Manages, trains, and structures staff to achieve the quality and quantity of work and service provided by team to ensure team meets production, billing and cash goals set for the department. Ensures system work lists and settings are providing the best work source for staff. Conducts meetings and works with staff identifying payor reimbursement issues. Assist in performing analysis to determine root causes (payor or hospital), for payment variance issues and resolution. Analyzes, recommends, & implements policies & procedures as needed to maximize reimbursement for services rendered in compliance with established government & third party guidelines. Close collaboration with hospital department managers to ensure timely charge submittal. Close collaboration with HIM/Coding Audit & Denial teams. Acquires and maintains thorough knowledge of Federal & State Legislative & Administrative action affecting reimbursement; disseminates acquired knowledge to leadership. "Risk Reporting" monthly as outlined by Office of Compliance . Audits posting of payments for purchased services, client & research billing. Coordinates all workflow issues & account concerns with PFS leadership. Performs other duties as assigned. Knowledge, Skills and Abilities Proficient computer skills, including MS Word, Excel and types minimum of 35 wpm. Requires strong interpersonal communication and documentation skills. Ability to spell with accurate data entry skills. Possesses a true "customer service" oriented work style. Knowledge of EPIC systems preferred. Knowledge of health care revenue cycle, versed in manage care contract interpretation. Effective oral and written skills. Evaluating and document employee performance. Advanced knowledge of A/R and managed care payer contracts. Advanced knowledge of healthcare A/R, collections, insurance, pre-authorizations, pre-registration, registration, financial counseling, and appeals. Advanced understanding of Compliance Guidelines. Knowledge of healthcare reimbursement methodologies. Advanced knowledge of the hospital based operations related to the revenue cycle including Health Information Management, Patient Access, Clinical Quality/case Management, Management Information Systems, Accounting and Finance. Excellent written and verbal communication and interpersonal skills PHYSICAL DEMANDS/WORKING CONDITIONS Physical Demands Carrying Handling Hearing Lifting Talking 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. 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!