Patient Financial Services Rep II, PFS

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

Representative II, PFS HB Technical Denials is responsible for the resolution of complex hospital billing denials and underpayments related to technical, billing, reimbursement, and claim processing issues. This role serves as a subject matter expert in UB-04 hospital billing requirements and payer-specific guidelines, with a strong emphasis on Tricare and VA reimbursement rules, claim filing requirements, authorization guidelines, and appeal strategies. The position requires critical thinking, strong payer negotiation skills, and the ability to independently manage a high-volume inventory while identifying denial trends and opportunities for process improvement.

• Work From Home: Candidates must live within the state of Texas or be willing to relocate within 4 weeks of the date of offer.

• Shift: 8-hour days, Monday through Friday flex-shift. Must begin by 9am each day.

Key Responsibilities

• Research and resolve complex hospital billing denials, rejections, and underpayments using Epic Resolute, payer portals, and other systems.
• Review claims for accuracy, compliance, and adherence to payer-specific requirements.
• Contact payers to research claim status, dispute denials, negotiate resolutions, and prepare effective written appeals.
• Apply Tricare, VA, Medicare, Medicaid, and commercial payer billing and reimbursement guidelines.
• Manage assigned work queues while meeting productivity, quality, and aging expectations.
• Collaborate with coding, billing, authorization, clinical, and operational teams to resolve claim issues.
• Identify denial trends, recurring payer issues, and process gaps; communicate findings and recommend improvements.
• Maintain compliance with regulatory, contractual, and organizational requirements.

Required Skills and Experience

• Strong knowledge of hospital billing, UB-04 claims, revenue codes, modifiers, reimbursement methodologies, and technical denials.
• Knowledge of Tricare and VA billing, reimbursement, and claim processes.
• Experience interpreting payer policies, denial codes, claim edits, and contractual requirements.
• Strong critical thinking, problem-solving, written communication, and payer negotiation skills.
• Ability to manage high-volume work independently while maintaining accuracy and quality.
• Proficiency with Epic Resolute, payer portals, and Microsoft Office.

Preferred Experience

• Hospital Business Office or Patient Financial Services experience.
• Experience with technical denials, payer disputes, appeals, and denial management.
• Experienced working with Tricare, VA, Medicare, Medicaid, and commercial payers.
• Experience with Epic Resolute and payer portals.

Team Culture

The PFS HB Technical Denials team is a collaborative, fast-paced team focused on maximizing reimbursement and reducing preventable denials. Successful team members are analytical, accountable, resilient, and committed to problem-solving, collaboration, and continuous improvement.

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 and
  

• Experience
  5 years hospital or medical billing experience.
  

Preferred

• Education
  Bachelor's Degree

JOB DUTIES

• Analyze payer underpayments, variances, and denials. Escalate trends, make comprehensive suggestions, and file professional appeals according to our contractual agreements and UT Southwestern policy. This includes timely processing of allocated volume of accounts, based on established production guidelines and time parameters provided for workflow.
• Responsible for outbound calls and/or status inquiries via payer's website validating receipt of medical claims and adjudication status within established timeframes. Display competent ability to access, navigate, and manage account information through phone calls and payer websites. Documents all work and calls performed, in accordance to policy. This includes complete contact information, good grammar, and expected outcomes.
• Display competency and ability to work within client based, research, and UTSW special arrangements. This includes, but is not limited to: calculating the physician and hospital share and working with MSP to transfer the physician's share to that department, working with other departments at UTSW to properly invoice clients and bill claims for proper adjudication per our agreements.
• Be knowledgeable on all payer types and effectively work on special projects for specific initiatives for account resolution projects. Demonstrate confidence and sound decision making for processing through large volumes of denials, complex accounts, or contractual reviews, as identified from strategic leadership requirements.
• Make necessary adjustments as required by plan reimbursement.
• Function as a departmental liaison for billing and collections support for internal and external customers, as required.
• Utilize systems tools and department resources to achieve production and quality targets for resolution of patient accounts.
• Investigates and responds to questions or requests for additional information in a timely and professional manner to ensure proper, timely and accurate payment of patient accounts.
• Maintains passing QA Scores
• Attends in-services, classes and meetings related to all operations to the PFS department. Understands reimbursement of all 3rd party payers.

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.