Insurance Specialist Ii - Revenue Cycle Department

JOB SUMMARY:
The Revenue Cycle Department - Ambulatory Patient Financial Clearance team has a new opportunity available for the role of Insurance Specialist II. This position will support the ever growing needs of Pre-Arrival Financial Services team with insurance verification and prior authorizations.
Quick tip(s):
Please review the section entitled experience/education and focus on the job requirements.
Make sure you include/show the experience listed under the requirements on your application.
KEY DUTIES:
Monitor and process insurance verification/eligibility
Pre-certification/eligibility on high volume complex offices/surgical procedures
Maintain productivity metrics
This will be a work from home position. Exact details shall be discussed as part of the interview process.
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 patients and employees. With over 20,000 employees, we are committed to continuing our growth with the best professionals in the healthcare industry. We invite you to be a part of the UT Southwestern team where you’ll discover teamwork, professionalism, and consistent opportunities for growth.
EXPERIENCE | EDUCATION:REQUIRED:
High school Diploma or equivalent
And three (3) to five (5) years of benefit verification/authorization experience or equivalent
FUNCTIONAL EXPERIENCES:
Functional - Customer Service/Customer service/1-3 Years
Functional - Clinical / Medical/Precertification/Predetermination/Authorizations/Verification/3-5 Years
TECHNOLOGY EXPERIENCES:
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End
User Technical - Desktop Tools/Microsoft Word/4-6 Years/End
User Technical – Office Equipment/Fax/Copier/4-6 Years/End User
JOB DUTIES:
Monitors the correct patient work queue to determine accounts needing verification.
Coordinates with physician's office and/or ancillary department regarding additional information needed to obtain pre-certification and insurance benefits.
Maintains department productivity standards.
Pre-registers patient cases by entering complete and accurate information prior to patient's arrival. Identifies and verifies all essential information pertaining to intake, insurance verification/eligibility, and precertification on all applicable patient accounts. Revises information in computer systems as needed
Documents pertinent information and efforts in computer system based upon department documentation standards.
Verifies insurance information by utilizing insurance websites or calling insurance companies to verify active coverage, deductible, copay, and any other specific information needed in accordance to the verification guidelines.
Create and call patients with cost estimate for scheduled appointments.
Ensures all exams are scheduled with proper patient class and clinical indicators and coding nomenclature.
Monitors, verifies, transcribes faxed documents to select insurance companies regarding authorization requests
Accurately monitors, reviews, data enters and processes authorizations and validate that the requests are accurate, within the required timeline, and in compliance with the applicable insurance guidelines.
Signs into and answers the assigned ACD line, documenting patient accounts per documentation expectations
Follows strict quality measures of documents scanned into the electronic medical record and/or submitted to applicable insurance
Protects the privacy and security of patient health information to ensure that confidentiality is maintained
Counsels offices and/or patients when an out of network situation becomes apparent or other potential payor technicalities arise. Coordinates as needed with other departments/ancillary areas for special needs or resources.
Verifies insurance coverage and eligibility for all applicable scheduled services specific to the type of procedure and/or exam, and site of service. Evaluates physician referral and authorization requirements and takes appropriate steps to ensure requirements are met prior to date of procedure. Tracks cases to resolution
Coordinates with case management, physician's office and/or ancillary department regarding any additional information needed on their part to obtain pre-certification and insurance benefits
Pre-Registers patient cases by entering complete and accurate information in EPIC ADT hospital billing system prior to the patient's arrival. Identifies/obtains/verifies all essential information pertaining to intake, insurance verification/eligibility and pre-certification on all applicable patients accounts with a 95% accuracy rate. Accurately revises information in computer systems as needed. Documents pertinent information and efforts in computer system based upon department documentation standards.
Confirms accuracy of scheduled procedure/s, observation, surgical observation, and day surgery patients when converted to inpatient status and validates that authorization codes match the service delivered including following best practice to obtained revised authorization for codes that are changed and have been communicated timely through proper channels.
Contacts patient as appropriate to collect critical information and/or to advise of benefits information and "out of network" situations. Coordinates with the financial counselor or other entity as appropriate and per customer satisfaction guidelines. Adheres to HIPAA guidelines when contacting patient.
Demonstrates ongoing competency skills including above level problem solving skills and decision- making abilities.
Maintains strictest confidentiality in accordance to policies and HIPAA guidelines.
Enters accurately prior authorization data and in accordance with established guidelines, including diagnosis of service and procedure codes.
Performs other related duties and projects as assigned. This job description should not be considered an exhaustive listing of all duties and responsibilities performed in this position. Our practice encourages all employees to develop personal and professional goals for themselves and will provide opportunities for continued growth and development.
KNOWLEDGE, SKILLS & ABILITIES:
Medicare/Medicaid/Government/Commercial Insurance Verification/Authorization Benefits
Management/Interacting with Medical Professionals/ADVANCED
Effective and Efficient Problem Solving
The use of initiative, strong independent judgement, and resourcefulness are inherent in the job
Ability to be self-supervising
Ability to interact with departmental management and communicate effectively in all patients and department interactions
WORKING CONDITIONS:
Work is performed primarily in general office area.
SECURITY:
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information
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.