Senior Reimbursement Specialist - Ophthalmology

Senior Reimbursement Specialist – Ophthalmology (911045)

Job Description

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!

Works under general supervision to provide policy analysis and recommendations to management related to reimbursement projects and functions.

• PPO medical plan, available day one at no cost for full‑time employee‑only coverage
• 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

Candidate must reside in the Dallas/Fort Worth metroplex. This position is primarily remote with some possibility for in‑office. Hours are mostly 8 am‑5 pm with some rotation with the team to cover earlier or later shifts. The team rotates covering 8:30 am‑5:30 pm, to ensure the clinic needs are covered.

• Education – High School Diploma or GED
• Experience – 6 years of progressively responsible experience in medical insurance, medical billing or medical reimbursement

• (CPC) CERT PROFESSIONAL CODER Upon Hire or
• Advanced Records Technician (ART) Upon Hire or
• (RRA) REGISTERED RECORDS ADMIN Upon Hire

• 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 as requested.
• Addresses and resolves plan alerts/errors and insurance filing order discrepancies.
• Reviews clinical documentation for CPT/diagnosis code information to support authorizations according to carrier guidelines.
• 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.
• Reviews assigned work queues (insurance verification, procedure/surgery authorizations), DAR, and makes recommendations for assignment changes.
• Ensures projects relating to insurance verification/procedure authorizations are completed on time and changes are implemented appropriately.
• Assists patients in signing up for copay…