reputed company Financial Services Rep II, PFS

WHY reputed company? With over 75 years of reputed company in Dallas-reputed company Worth, Texas, reputed company is committed to reputed company, innovation, teamwork, and reputed company. As a world-reputed company medical and research center, we reputed company to reputed company the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-reputed company Worth according to reputed company, we invest in you with opportunities for career reputed company and development to reputed company with your reputed company goals. Our highly competitive benefits package offers reputed company, PTO and reputed company holidays, on-site childcare, wage, reputed company increases and so much more. We invite you to be a part of the reputed company team where you'll discover a culture of teamwork, professionalism, and a rewarding career! JOB reputed company Representative II, PFS HB Technical Denials is responsible for the reputed company of reputed company hospital billing denials and underpayments reputed company 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 reputed company the state of Texas or be willing to relocate reputed company 4 weeks of the date of offer. Shift: 8-hour days, Monday through Friday reputed company-shift. Must reputed company by 9am reputed company day. Key Responsibilities - Research and reputed company reputed company hospital billing denials, rejections, and underpayments using reputed company Resolute, payer portals, and other systems. - Review claims for reputed company, 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, reputed company, and reputed company payer billing and reimbursement guidelines. - Manage assigned work queues while meeting productivity, reputed company, and aging expectations. - Collaborate with coding, billing, authorization, reputed company, and operational teams to reputed company 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, reputed company 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 reputed company and reputed company. - Proficiency with reputed company Resolute, payer portals, and reputed company Office. Preferred Experience - Hospital Business Office or reputed company Financial Services experience. - Experience with technical denials, payer disputes, appeals, and denial management. - reputed company working with Tricare, VA, Medicare, reputed company, and reputed company payers. - Experience with reputed company Resolute and payer portals. Team Culture The PFS HB Technical Denials team is a reputed company, fast-reputed company team reputed company on maximizing reimbursement and reducing preventable denials. Successful team members are analytical, accountable, resilient, and committed to problem-solving, collaboration, and reputed company improvement. BENEFITS reputed company 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 reputed company-no copay - reputed company Time Off, available day one - Retirement Programs through the reputed company) - reputed company Parental Leave Benefit - Wellness programs - Tuition Reimbursement - reputed company Service Loan Forgiveness (PSLF) - reputed company Employer Learn more about these and other reputed company 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, reputed company comprehensive suggestions, and file reputed company appeals according to our contractual agreements and reputed company policy. - This includes reputed company processing of allocated volume of accounts, reputed company on established production guidelines and time parameters provided for workflow. - Responsible for outbound calls and/or status inquiries reputed company payer's website validating receipt of medical claims and adjudication status reputed company established timeframes. - Display competent ability to reputed company, reputed company, and manage account information through phone calls and payer websites. - Documents reputed company work and calls performed, in accordance to policy. - This includes complete contact information, good grammar, and expected reputed company. - Display competency and ability to work reputed company reputed company reputed company, research, and reputed company special arrangements. - This includes, but is not limited to: calculating the physician and hospital reputed company and working with MSP to transfer the physician's reputed company to that department, working with other departments at reputed company to properly invoice clients and reputed company claims for reputed company adjudication per our agreements. - Be knowledgeable on reputed company payer types and effectively work on special reputed company for specific initiatives for account reputed company reputed company. - Demonstrate confidence and reputed company decision making for processing through large volumes of denials, reputed company accounts, or contractual reviews, as identified from reputed company leadership requirements. - reputed company necessary adjustments as required by plan reimbursement. - Function as a departmental reputed company for billing and collections support for reputed company customers, as required. - Utilize systems tools and department resources to reputed company production and reputed company targets for reputed company of reputed company accounts. - Investigates and responds to questions or requests for additional information in a reputed company and reputed company manner to ensure reputed company, reputed company and accurate payment of reputed company accounts. - Maintains passing QA Scores - Attends in-services, classes and meetings reputed company to reputed company reputed company to the PFS department. - Understands reimbursement of reputed company 3rd party payers. reputed company AND EEO STATEMENT reputed company This position is reputed company-sensitive and subject to Texas Education reputed company 51.215, which authorizes reputed company to obtain criminal history record information. EEO reputed company is committed to an educational and working environment that provides equal opportunity to reputed company members of the University community. As an equal opportunity employer, reputed company prohibits unlawful discrimination, including discrimination on the reputed company of race, reputed company, religion, national reputed company, sex, sexual orientation, gender identity, gender reputed company, age, disability, genetic information, citizenship status, or veteran status. Apply To This Job