Insurance Specialist II

UT Southwestern Medical Center • Dallas, TX

2d • Remote

About The Position

The Insurance Specialist II is responsible for completing insurance verifications, obtaining prior authorizations, and coordinating referral requirements for scheduled Cancer Center services.
Ensures accurate eligibility and benefit information is obtained, payer requirements are met prior to the date of service, and encounters are properly prepared for billing.
Works closely with clinical departments, payers, and patients to resolve coverage issues, secure required authorizations, and ensure financial clearance for appointments.
Plays a critical role in reducing delays in care, minimizing denials, and supporting an efficient revenue cycle.
Experience with TriWest authorizations is ideal.
Candidates must live in Texas, DFW area applicants are preferred but not mandatory.
WFH: This is a WFH position. However, applicants must live in Texas, DFW area preferred.
Shift: 8am-5pm, Monday through Friday

Requirements

• High School diploma or equivalent
• 3 years of benefit verification/authorization experience or equivalent and
• 1 year Customer Service/Customer service and
• 3 years Clinical / Medical/Precertification/Predetermination/Authorizations/Verification and
• 4 years end user Desktop Tools, Microsoft Outlook, Microsoft Word, Office Equipment/Fax/Copier and
• 1 year of EPIC experience.

Nice To Haves

• Experience with TriWest authorizations is ideal.

Responsibilities

• 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
• 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%25 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 the strictest confidentiality in accordance to 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.

Benefits

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100%25 coverage for preventive healthcare-no copay
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED