Manager, Hospital Denials

6 days ago

Dallas, TX, United States UT Southwestern Medical Center Full time
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 successful applicant 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. Given our continued focus on automation and digital transformation, we strongly prefer candidates with experience leveraging AI tools and bot-enabled workflows to enhance denials management and overall revenue cycle efficiency.

Some of the key responsibilities include the following:
  • Strong experience with EPIC Resolute-particularly in Rev Cycle workflows-is highly preferred for this role.
  • Leadership and Team Management
  • Technical Denials Management
  • Operations Oversight
  • Technology and Innovation
  • Stakeholder Collaboration
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.
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.

  • Manager, Hospital Denials

    5 days ago

    Dallas, TX, United States University Of Texas Southwestern Medical Cent (The) Full time

    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...

  • Manager, Hospital Denials

    7 days ago

    Dallas, TX, United States University Of Texas Southwestern Medical Cent (The) Full time

    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...

  • Mgr., PFS Denials/Collections

    1 week ago

    Dallas, TX, United States Parkland Health and Hospital System Full time

    Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a...

  • Medical Claims Denial Management Specialist

    1 week ago

    Dallas, TX, United States Delta Dallas Full time

    Medical Claims Denial Management Specialist - Addison, TXPay: $27/hrSchedule: 100% on-site - amazing company culture!We are looking for a detail-oriented professional to review, analyze, and resolve denied or underpaid medical claims. The ideal candidate will have 2-4 years of experience in medical billing, claims processing, or denial management, strong...

  • Medical Claims Denial Management Specialist

    2 weeks ago

    Dallas, TX, United States Delta Dallas Full time

    Medical Claims Denial Management Specialist - Addison, TXPay: $27/hrSchedule: 100% on-site - amazing company culture!We are looking for a detail-oriented professional to review, analyze, and resolve denied or underpaid medical claims. The ideal candidate will have 2-4 years of experience in medical billing, claims processing, or denial management, strong...

  • Medical Claims Denial Management Specialist

    1 week ago

    Dallas, TX, United States Delta Dallas Full time

    Medical Claims Denial Management Specialist - Addison, TXPay: $27/hrSchedule: 100% on-site - amazing company culture!We are looking for a detail-oriented professional to review, analyze, and resolve denied or underpaid medical claims. The ideal candidate will have 2-4 years of experience in medical billing, claims processing, or denial management, strong...

  • Medical Claims Denial Management Specialist

    7 days ago

    Dallas, TX, United States Delta Dallas Full time

    Medical Claims Denial Management Specialist - Addison, TXPay: $27/hrSchedule: 100% on-site - amazing company culture!We are looking for a detail-oriented professional to review, analyze, and resolve denied or underpaid medical claims. The ideal candidate will have 2-4 years of experience in medical billing, claims processing, or denial management, strong...

  • Medical Claims Denial Management Specialist

    6 days ago

    Dallas, TX, United States Delta Dallas Full time

    Medical Claims Denial Management Specialist - Addison, TXPay: $27/hrSchedule: 100% on-site - amazing company culture!We are looking for a detail-oriented professional to review, analyze, and resolve denied or underpaid medical claims. The ideal candidate will have 2-4 years of experience in medical billing, claims processing, or denial management, strong...

  • Utilization Management Coordinator

    1 week ago

    Dallas, TX, United States Texas Institute for Surgery Full time

    Job DetailsJob Location Texas Institute for Surgery LL SURG - Dallas, TX Position Type Full-time Description Position TitleDepartmentUtilization Management CoordinatorBusiness OfficeDirect Manager of PositionExempt StatusDirector, Business Services False False False Center False Exempt X False False False Center False 1 NonexemptJob SummaryThe Utilization...

  • Medical Collections Specialist Sr

    6 days ago

    Dallas, TX, United States SCP Health Full time

    At SCP Health, what you do matters As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical...