JOB SUMMARY:

The Department of Revenue Cycle - Ambulatory Patient Financial Services has a new opportunity available for an Insurance Specialist II. The duties for this role will include but not be limited to the following:

• Responsible for obtaining information to initiate verification and precertification process.
• Fast paced role that requires good time management.
• Ability to multi-task Utilize clear and concise documentation
• Understanding of insurance plans and how to review the payers medical policies.

This is a work from home position. Additional 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 GED
• 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
• Technical–EPIC/1-3Years

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 monitor, review, data entry and process authorizations and validate that the requests are accurate, within the required timeline, and in compliance with the applicable insurance guidelines
• 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 critical thinking skills and decision- making abilities. 
• Maintains the strictest confidentiality in accordance with policies and HIPAA guidelines With general oversight follow our current policies and procedures and responds to administrative directives. 
• Enters accurately prior authorization data and in accordance with established guidelines, including diagnosis of service and procedure codes. 
• Promotes team engagement 
• 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 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.