Insurance Specialist II

%3Cp%3E%3Cstrong%3EWHY UT SOUTHWESTERN?%3C/strong%3E%3Cbr%3EWith 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 number 1 hospital in Dallas-Fort Worth according to %3Ca href=%22https://www.utsouthwestern.edu/newsroom/articles/year-2022/july-us-news-best-hospital.html%22 target=%22_blank%22%3EU.S. News %26amp; World Report%3C/a%3E, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you%27ll discover a culture of teamwork, professionalism, and a rewarding career!%26nbsp;%3C/p%3E%3Cp%3E%3Cstrong%3EJOB SUMMARY%3C/strong%3E%3C/p%3E%3Cp class=%22MsoNormal%22%3EUT Southwestern Medical Center has a new opportunity for an Insurance Specialist II. We are seeking a detail-oriented and dependable professional to join our team in a high-volume, metric-driven role focused on insurance verification and authorization. The ideal candidate will have prior experience in a hospital or medical office setting, with a strong understanding of healthcare insurance processes.%3C/p%3E%3Cp class=%22MsoNormal%22%3EThis position requires accuracy, efficiency, and the ability to meet performance metrics in a fast-paced environment. Candidates must be comfortable working with various insurance providers, electronic health records (EHR) systems, and collaborating closely with clinical and administrative teams to ensure timely and accurate authorizations.%3C/p%3E%3Cul style=%22margin-top:0in;%22 type=%22disc%22%3E%3Cli class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EWork From Home (WFH): This is a WFH position. Applicant must live in TX. %26nbsp;%3C/span%3E%3C/li%3E%3Cli class=%22MsoNormal%22 style=%22mso-list:l0 level1 lfo1;tab-stops:list .5in;%22%3E%3Cspan style=%22mso-fareast-font-family:%26quot;Times New Roman%26quot;;%22%3EShift: Flex-start 8-hour days, Monday through Friday%3C/span%3E%26nbsp;%3C/li%3E%3C/ul%3E%3Cp%3E%3Cstrong%3EBENEFITS%3C/strong%3E%3Cbr%3EUT 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:%3C/p%3E%3Cul%3E%3Cli%3EPPO medical plan, available day one at no cost for full-time employee-only coverage%3C/li%3E%3Cli%3E100% coverage for preventive healthcare-no copay%3C/li%3E%3Cli%3EPaid Time Off, available day one%3C/li%3E%3Cli%3ERetirement Programs through the Teacher Retirement System of Texas (TRS)%3C/li%3E%3Cli%3EPaid Parental Leave Benefit%3C/li%3E%3Cli%3EWellness programs%3C/li%3E%3Cli%3ETuition Reimbursement%3C/li%3E%3Cli%3EPublic Service Loan Forgiveness (PSLF) Qualified Employer%3C/li%3E%3Cli%3E%3Ca href=%22http://jobs.utsouthwestern.edu/benefits/#top%22 target=%22_blank%22%3ELearn more about these and other UTSW employee benefits!%3C/a%3E%3C/li%3E%3C/ul%3E%3Cp%3E%3Cbr%3E%3Cbr%3E%3Cstrong%3EEXPERIENCE AND EDUCATION%3C/strong%3E%3Cbr%3E%3Cbr%3E%3Cstrong%3ERequired%3C/strong%3E%3C/p%3E%3Cul%3E%3Cli%3E%3Cstrong%3EEducation%3C/strong%3E%3Cbr%3EHigh School diploma or equivalent%26nbsp;%3Cbr%3E%26nbsp;%3C/li%3E%3C/ul%3E%3Cul%3E%3Cli%3E%3Cstrong%3EExperience%3C/strong%3E%3Cbr%3E3 years of benefit verification/authorization experience or equivalent and%26nbsp;%3Cbr%3E1 year Customer Service/Customer service and%26nbsp;%3Cbr%3E3 years Clinical / Medical/Precertification/Predetermination/Authorizations/Verification and%26nbsp;%3Cbr%3E4 years end user Desktop Tools, Microsoft Outlook, Microsoft Word, Office Equipment/Fax/Copier and%26nbsp;%3Cbr%3E1 year of EPIC experience.%26nbsp;%3Cbr%3E%26nbsp;%3C/li%3E%3C/ul%3E%3Cp%3E%3Cbr%3E%3Cstrong%3EJOB DUTIES%3C/strong%3E%3C/p%3E%3Cul%3E%3Cli%3EMonitors the correct patient work queue to determine accounts needing verification.%3C/li%3E%3Cli%3ECoordinates with physician%27s office and/or ancillary department regarding additional information needed to obtain pre-certification and insurance benefits.%3C/li%3E%3Cli%3EMaintains department productivity standards.%3C/li%3E%3Cli%3EPre-registers patient cases by entering complete and accurate information prior to patient%27s 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.%3C/li%3E%3Cli%3EDocuments pertinent information and efforts in computer system based upon department documentation standards.%3C/li%3E%3Cli%3EVerifies 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.%3C/li%3E%3Cli%3ECreate and call patients with cost estimate for scheduled appointments.%3C/li%3E%3Cli%3EEnsures all exams are scheduled with proper patient class and clinical indicators and coding nomenclature.%3C/li%3E%3Cli%3EMonitors, verifies, transcribes faxed documents to select insurance companies regarding authorization requests%3C/li%3E%3Cli%3EAccurately 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%3C/li%3E%3Cli%3EFollows strict quality measures of documents scanned into the electronic medical record and/or submitted to applicable insurance%3C/li%3E%3Cli%3EProtects the privacy and security of patient health information to ensure that confidentiality is maintained%3C/li%3E%3Cli%3ECounsels 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.%3C/li%3E%3Cli%3EVerifies 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%3C/li%3E%3Cli%3ECoordinates with case management, physician%27s office and/or ancillary department regarding any additional information needed on their part to obtain pre-certification and insurance benefits%3C/li%3E%3Cli%3EPre-Registers patient cases by entering complete and accurate information in EPIC ADT hospital billing system prior to the patient%27s 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.%3C/li%3E%3Cli%3EConfirms 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.%3C/li%3E%3Cli%3EContacts patient as appropriate to collect critical information and/or to advise of benefits information and %22out of network%22 situations. Coordinates with the financial counselor or other entity as appropriate and per customer satisfaction guidelines. Adheres to HIPAA guidelines when contacting patient.%3C/li%3E%3Cli%3EPerforms other duties as assigned.%3C/li%3E%3Cli%3EDemonstrates ongoing competency skills including above level problem solving skills and decision- making abilities.%3C/li%3E%3Cli%3EMaintains the strictest confidentiality in accordance to policies and HIPAA guidelines%3C/li%3E%3Cli%3EWith general oversight follow our current policies and procedures and responds to administrative directives.%3C/li%3E%3Cli%3EEnters accurately prior authorization data and in accordance with established guidelines, including diagnosis of service and procedure codes.%3C/li%3E%3Cli%3EPromotes team engagement%3C/li%3E%3Cli%3EPerforms 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.%3C/li%3E%3C/ul%3E%3Cp%3E%3Cstrong%3ESECURITY AND EEO STATEMENT%3C/strong%3E%3Cbr%3E%3Cbr%3E%3Cstrong%3ESecurity%3C/strong%3E%3Cbr%3EThis position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.%3Cbr%3E%3Cbr%3E%3Cstrong%3EEEO%3C/strong%3E%3Cbr%3EUT 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.%3Cbr%3E%26nbsp;%3C/p%3E