Job Description

Insurance Specialist I Location Dallas, TX (Design District area) : Essential Functions 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. Performs other duties as assigned. 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 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. Minimum Qualifications Education/Experience High school Two (2) to four (4) years of benefit verification/authorization experience or equivalent. Knowledge, Skills, & Abilities Functional Experiences Functional - Customer Service/Customer service/1-3 Years Functional - Clinical / Medical/Precertification/Predetermination/Authorizations/Verification/2-4 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 Required Skills Medicare/Medicaid/Government/Commercial Insurance Verification/Authorization Benefits Management/Interacting with Medical Professionals/ADVANCED Effective and Efficient Problem Solving Ability to read and write effectively Ability to interact with departmental management and communicate effectively in all patients and department interactions The following is the acronym, "PACT", and is fundamental to all non clinical positions at UT Southwestern Medical Center: P-Problem Solving: Employees take ownership in solving problems effectively, efficiently, and to the satisfaction of customers, or managers. They show initiative in addressing areas of concern before they become problems. A-Ability, Attitude and Accountability: Employees exhibit ability to perform their job and conduct themselves in a professional and positive manner reflecting a professional environment readily assuming obligations in a dependable and reliable manner. C-Communication, Contribution, and Collaboration: Who are our Customers? Anyone who requests our help, needs our work product, or receives our services. Employees focus on customer service with creative solutions while improving the customer experience through clear, courteous, and timely delivery and communication. Sharing ideas with others helps expand our contribution to department goals. T-Teamwork: Employees work to contribute to the department's success by supporting co-workers, promoting excellence in work product and customer service, and in maintaining a satisfying, caring environment for each other. Working Conditions Work is performed primarily in general office area. Any qualifications to be considered as equivalents in lieu of stated minimum require prior approval of Vice President for Human Resources Administration or his/her designee. 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 #1 hospital in Dallas-Fort Worth for the fifth consecutive year, we invite you to continue your healthcare career with us at William P. Clements Jr. University Hospital. You'll discover a culture of teamwork, professionalism, and consistent opportunities for learning and advancement into leadership roles. Compliance with the COVID-19 vaccine mandate enforced by the Centers for Medicare and Medicaid (CMS) is a requirement for this position. Federal law requires individuals holding this position to be fully vaccinated or have an approved exemption for certain medical, disability, or religious reasons. Individuals who do not meet CMS vaccination requirements are not eligible and should not apply for this position but are encouraged to apply for other non-healthcare positions at UT Southwestern for which they qualify. For COVID-19 vaccine information, applicants should visit To learn more about the benefits UT Southwestern offers, visit 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. To learn more, please visit: why-work-here/diversity-inclusion

Job Tags

Full time, Work at office,

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