UT Southwestern Medical Center
Insurance Specialist I - Pre Arrival Financial Services
UT Southwestern Medical Center, Dallas, Texas, United States, 75215
INSURANCE SPECIALIST I
JOB SUMMARY:Why UT Southwestern?With over 75 years of excellence 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 will discover teamwork, professionalism, and consistent opportunities for growth.
UT Southwestern Medical Center has a new employment opportunity available within the Pre-Arrival Financial Services Department team for the role of Insurance Specialist I.
Work From Home (WFH): This is a WFH position. However, initial training will be onsite and will last 2-4 weeks, depending on experience (DOE). Must live within the Greater DFW area, 45 minutes or less. Additional details shall be discussed as part of the interview process.
Shift: 8:30am-5:00pm, Monday through Friday
Quick Tips:
Please review the experience/education section thoroughly to verify that you qualify.
Please list all applicable experience on your application to make sure we credit you properly.
VETERANS:We are honored to be a veteran friendly work environment that is home to hundreds of veterans. We value your integrity, dedication, and the commitment you have made to our country. We are proud to support your next mission. Ranked by Forbes as one of the Top 10 National Employers, we invite you to be a part of the UT Southwestern Medical Center team where you will discover teamwork, professionalism, and consistent opportunities for growth.
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.
Verify insurance information by utilizing insurance websites or calling insurance companies to verify active coverage, deductible, copay, and any other specific information needed in accordance with the verification guidelines.
Create and call patients with cost estimates 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 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.
EDUCATION/EXPERIENCE:
High school
And two (2) to four (4) years of benefit verification/authorization experience or equivalent.
KNOWLEDGE, SKILLS, & ABILITIES:FUNCTIONAL EXPERIENCES
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.
WORKING CONDITIONSWork is performed primarily in general office area.
SECURITY:This position is security-sensitive and thereby subject to the provisions of 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.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 coverage100% coverage for preventive healthcare – no copayPaid Time Off, available day oneRetirement Programs through the Teacher Retirement System of Texas (TRS)Paid Parental Leave BenefitWellness programsTuition ReimbursementPublic Service Loan Forgiveness (PSLF) Qualified EmployerLearn more about these and other UTSW employee benefits!
JOB SUMMARY:Why UT Southwestern?With over 75 years of excellence 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 will discover teamwork, professionalism, and consistent opportunities for growth.
UT Southwestern Medical Center has a new employment opportunity available within the Pre-Arrival Financial Services Department team for the role of Insurance Specialist I.
Work From Home (WFH): This is a WFH position. However, initial training will be onsite and will last 2-4 weeks, depending on experience (DOE). Must live within the Greater DFW area, 45 minutes or less. Additional details shall be discussed as part of the interview process.
Shift: 8:30am-5:00pm, Monday through Friday
Quick Tips:
Please review the experience/education section thoroughly to verify that you qualify.
Please list all applicable experience on your application to make sure we credit you properly.
VETERANS:We are honored to be a veteran friendly work environment that is home to hundreds of veterans. We value your integrity, dedication, and the commitment you have made to our country. We are proud to support your next mission. Ranked by Forbes as one of the Top 10 National Employers, we invite you to be a part of the UT Southwestern Medical Center team where you will discover teamwork, professionalism, and consistent opportunities for growth.
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.
Verify insurance information by utilizing insurance websites or calling insurance companies to verify active coverage, deductible, copay, and any other specific information needed in accordance with the verification guidelines.
Create and call patients with cost estimates 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 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.
EDUCATION/EXPERIENCE:
High school
And two (2) to four (4) years of benefit verification/authorization experience or equivalent.
KNOWLEDGE, SKILLS, & ABILITIES:FUNCTIONAL EXPERIENCES
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.
WORKING CONDITIONSWork is performed primarily in general office area.
SECURITY:This position is security-sensitive and thereby subject to the provisions of 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.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 coverage100% coverage for preventive healthcare – no copayPaid Time Off, available day oneRetirement Programs through the Teacher Retirement System of Texas (TRS)Paid Parental Leave BenefitWellness programsTuition ReimbursementPublic Service Loan Forgiveness (PSLF) Qualified EmployerLearn more about these and other UTSW employee benefits!