United States · On-site
PRIMARY PURPOSE Reviews, analyzes, and adjudicates professional claims, claim appeals, corrected claims and refunds from UTSW for physician services performed on Parkland unfunded patients, to ensure accurate records and…
Skills: Claims Adjudication, Data Analysis, Medicare Billing, Texas Medicaid Guidelines, ICD10
United States · On-site
$5,000 Sign on Bonus Primary Purpose Provides nutritional education and nutritional patient care to the assigned patient population to ensure that patients receive optimal nutritional care at Parkland. MINIMUM SPECIFICAT…
Skills: Nutritional Education, Patient Care, Clinical Nutrition, Medical Nutrition Therapy, Electronic Medical Record Charting
Dallas, Texas, United States · On-site
Primary Purpose Responsible for providing health care for patients in designated primary or specialty area, including patient diagnoses, treatment, education and referrals. Serves as a resource and role model for clinica…
Skills: Patient Diagnosis, Treatment Planning, Patient Education, Clinical Leadership, Medical Decision Making
Intake, Montana, United States · On-site
Work Schedule: Full Time Shift: 6am - 6pm (Rotational) Days PRIMARY PURPOSE The RN is a licensed professional who uses the Parkland nursing professional practice model to coordinate patient care delivery by the health ca…
Skills: Patient Assessment, Nursing Process, Care Coordination, Patient Education, Interpersonal Communication
United States · On-site
Primary Purpose Responsible for the operational delivery of the Epic security build for Parkland's Epic system including quality assurance activities that promote standardization, reliability, and secure application inte…
Skills: Epic Security Management, Epic Chronicles, Quality Assurance, Critical Thinking, Collaboration
United States · On-site
PRIMARY PURPOSE Serves as an experienced attorney, contributing to the Legal Affairs Department's execution of core legal services and capable of health law practice with leader coordination and support rather than super…
Skills: Healthcare Law, Contract Negotiation, Regulatory Compliance, Litigation Management, Corporate Governance
Parkland, Florida, United States · On-site
Primary Purpose Responsible for providing direct and/or indirect health care services to assigned patient population. Minimum Specifications Education Must have a Doctor of Medicine or Doctor of Osteopathy degree from an…
Skills: Patient Care Management, Obstetrics, Gynecology, Physical Examinations, Medical Diagnosis
United States · On-site
Full Time - Days - North Tower PRIMARY PURPOSE Responsible for providing total nursing care for assigned patients, under the guidance of a Registered Nurse, in order to ensure quality care. MINIMUM SPECIFICATIONS Educati…
Skills: Patient Care, Patient Screening, Clinical Documentation, Patient Education, Medical Instrument Sterilization
United States · On-site
PRIMARY PURPOSE The RN is a licensed professional who uses the Parkland nursing professional practice model to coordinate patient care delivery, that focuses on a particular patient population(s)/specific health conditio…
Skills: Oncology Nursing, Chemotherapy Administration, Immunotherapy, Intravenous Access, Central Line Maintenance
United States · On-site
Shift- Days (7am- 5:30pm) Work Days: 2- 10hr shifts per week Employment Type: Part Time PRIMARY PURPOSE The RN is a licensed professional who uses the Parkland nursing professional practice model to coordinate patient ca…
Skills: Chemotherapy Administration, Immunotherapy, Intravenous Access, Central Line Maintenance, Patient Assessment
Dallas, Texas, United States · On-site
Work Schedule: Full Time - Days Shift - 8 am to 5 pm Monday - Fridays PRIMARY PURPOSE Responsible for providing total nursing care for assigned patients, under the guidance of a Registered Nurse, in order to ensure quali…
Skills: Patient Care, Patient Screening, Care Coordination, Chronic Disease Management, Telehealth
United States · On-site
Work Schedule: Full-time Rotating (36 hours/week), with rotating weekends and holidays. Incumbent have flexibility of shift options, with the ability to choose between 8-hour, 10-hour, or 12-hour shifts as long as the sh…
Skills: Poison Information Services, Nursing Standards, Oral Communication, Written Communication, Mathematical Computations
United States · On-site
Primary Purpose Provides specialized integrated clinical pharmacy services for an assigned area. Provides leadership in education and practice of evidence based medication use and optimal patient outcomes. Minimum Specif…
Skills: Pharmacotherapy, Medication Therapy Management, Clinical Pharmacy, Patient Education, Drug Information
Dallas, Texas, United States · On-site
PRIMARY PURPOSE Provides Lead Technician direction to departmental personnel assuring the timely delivery of environmental services, sanitation, cleanliness, and safety in a timely manner and promotes harmonious relation…
Skills: Sanitation Techniques, Cleaning Equipment Operation, Staff Training, Waste Disposal, Customer Service
United States · On-site
Work Schedule - Days Shift - 8 am to 5pm Monday- Friday Full Time PRIMARY PURPOSE The RN is a licensed professional who uses the Parkland nursing professional practice model to coordinate patient care delivery, that focu…
Skills: Oncology Nursing, Chemotherapy Administration, Intravenous Access, Central Line Maintenance, Patient Assessment
Parkland, Florida, United States · On-site
**DAY SHIFT** Full Time Position Primary Purpose The RN is a licensed professional who uses the Parkland nursing professional practice model to coordinate patient care delivery by the health care team. Using the nursing …
Skills: Patient Assessment, Nursing Process, Care Coordination, Interpersonal Communication, Clinical Judgment
United States · On-site
Primary Purpose Responsible for the day-to-day management, training, coaching, and development of assigned staff for environmental and custodial services. To provide an environment where we partner with Infection Prevent…
Skills: Staff Management, Infection Prevention, Budget Monitoring, Customer Service, Critical Thinking
United States · On-site
PRIMARY PURPOSE Responsible for coordinating pre/post-transplant patient care throughout all phases of the transplant process. This includes, but is not limited to, providing patient education, coordinating evaluation te…
Skills: Patient Education, Clinical Coordination, Case Management, Triage, Discharge Planning
United States · On-site
Primary Purpose Responsible for providing health care for patients in designated primary or specialty area, including patient diagnoses, treatment, education and referrals. Serves as a resource and role model for clinica…
Skills: Patient Diagnosis, Treatment Planning, Patient Education, Clinical Leadership, Physical Examinations
United States · On-site
Primary Purpose Responsible for producing and serving meals in retail, patient services, sanitation area or production environment in the Nutrition Services Department. Minimum Specifications Education None. Experience N…
Skills: Food Production, Meal Service, Sanitation Procedures, Communication, Basic Computer Skills
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The role involves reviewing and adjudicating professional claims and appeals for physician services to ensure accuracy and contractual compliance. It also requires performing detailed data analysis and quality assurance to identify trends and provide recommendations to leadership.
Candidates must have a bachelor's degree in a health or finance-related field and five years of experience in medical insurance claims or accounting. Proficiency in Medicare/Medicaid regulations, SQL reporting, and medical coding (ICD10/CPT) is required.
PRIMARY PURPOSE
Reviews, analyzes, and adjudicates professional claims, claim appeals, corrected claims and refunds from UTSW for physician services performed on Parkland unfunded patients, to ensure accurate records and disposition of claims in accordance with contractual business rules. Performs claims data analysis and presents results and recommendations to the department leadership.
MINIMUM SPECIFICATIONS
Education
Bachelor's degree in health or finance-related field is required.
Experience
Equivalent Education and/or Experience
May have an equivalent experience in lieu of specific education.
Certification/Registration/Licensure
None.
Skills or Special Abilities
Must understand managed care and government payers' reimbursement principles, billing and claim adjudication processes.
Must be able to observe emerging trends and track them using analytics and critical thinking methods.
Must have a demonstrated ability to develop clean, insightful, and easily digestible potential financial impact and claims data.
Must be able to conduct financial reconciliation projects using logic, revenue cycle and professional billing/claim adjudication knowledge with criteria and data elements provided.
Must be able to demonstrate expertise with SQL reporting (example: Crystal Reports). Must be able to prepare detailed and summary reports and charts.
Must have expert level skills in Microsoft software, including Word, Excel, Access, PowerPoint, Outlook, and Visio.
Skilled with the ability to receive strategic direction and execute with minimal supervision
Must be detail oriented, organized, and possess strong analytical and mathematical skills to ensure accurate and timely processing of accounting records and resolve complex accounting issues.
Must demonstrate ability to meet deadlines while balancing competing demands.
Must demonstrate ability to identify and research data irregularities.
Must be able to solve problems within the guidelines of established policies and procedures.
Must be able to communicate effectively with internal and external customers. Must be customer service oriented.
Must have experience with project management methodology.
Responsibilities
Analyzes, documents, and adjudicates monthly claims data, appeals, corrected claims and refunds for professional clinical services for Parkland covered patients.
Performs a detailed quality assurance of claims processed by the Third-Party Administrator (TPA). Generates patient eligibility and coverage reporting from EPIC and validates patient's unfunded status.
Provides data management support and creates custom reports to illustrate claim adjudication trends and issues for administration. Implements recommended revisions to process or TPA system set up as needed, to streamline claim, appeals and refunds adjudication.
Identifies trends in TPA errors that have resulted in appeal claims. Reports those trends to Manager of Department Systems and assists with corrective measures with the TPA or UT Southwestern Finance team.
Collects and aggregates claims data, translates business questions from the leadership team and translates them into analytical solutions. Presents analysis results/recommendations to the leaders in a timely, consistent, and accurate manner.
Provides revenue reporting and data extracts for an annual Divisional Guarantees reconciliation process.
Collaborates with internal IT and external TPA vendor to ensure adherence to the UT Contract business rules of adjudication. Works to ensure annual updates and modifications to the business rules are implemented.
Work with large data for ad hoc reporting and trend analysis for UT Contracts Team.
Validates denial reasons and ensures coding is accurate and reflects the denial reasons. Coordinates with the Nurse Auditor for clinical consultations or account referrals when necessary.
Provides guidance and support to all UT Contracts personnel toward resolution of claim-related issues with an emphasis on root-cause analysis and problem resolution.
Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.
Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.
Parkland Health first opened its doors in 1894 and is now one of the largest public hospital systems in the country. The hospital averages more than 1 million outpatient visits annually. Services include a Level I Trauma Center, the only verified burn center in North Texas and a Level III Neonatal Intensive Care Unit. The system also includes 20 community-based clinics, including primary care and women's clinics, 12 school-based clinics and numerous outreach and education programs. Parkland is the primary teaching hospital for the University of Texas Southwestern Medical Center. Despite our growth for more than 100 years, our mission and vision remain the same – to care for you and your family. Thank you for choosing Parkland.
Offices: 5200 Harry Hines Blvd., Dallas, Texas 75235, US
Parkland Health first opened its doors in 1894 and is now one of the largest public hospital systems in the country. The hospital averages more than 1 million outpatient visits annually. Services include a Level I Trauma Center, the only verified burn center in North Texas and a Level III Neonatal Intensive Care Unit. The system also includes 20 community-based clinics, including primary care and women's clinics, 12 school-based clinics and numerous outreach and education programs. Parkland is the primary teaching hospital for the University of Texas Southwestern Medical Center. Despite our growth for more than 100 years, our mission and vision remain the same – to care for you and your family. Thank you for choosing Parkland.
Offices: 5200 Harry Hines Blvd., Dallas, Texas 75235, US
