Reimbursement Specialist - Ophthalmology Insurance/Auth

UT Southwestern Medical Center • Dallas, TX

1d

About The Position

Works under moderate supervision to provide policy analysis and recommendations to management related to reimbursement projects and functions.

Requirements

• High School Diploma or equivalent
• 4 years of progressively responsible experience in medical insurance, medical billing or medical reimbursement.

Nice To Haves

• (CPC) CERT PROFESSIONAL CODER Upon Hire or
• Advanced Records Technician (ART) Upon Hire or
• (RRA) REGISTERED RECORDS ADMIN Upon Hire

Responsibilities

• Performs insurance verification/eligibility and completes precertification on all applicable patient accounts.
• Identifies and verifies essential information pertaining to guarantor/subscriber.
• Monitors patient work queues/DAR to review accounts that require estimates, verification and/or authorization.
• Reviews clinical documentation for CPT/diagnosis code information to support authorizations according to carrier guidelines.
• Verifies patient insurance benefits and eligibility for all applicable scheduled services specific to the type of appointment, procedure and/or exam, and site of service via carrier websites or calling insurance companies.
• Address and resolve plan alerts/errors and insurance filing order discrepancies.
• Ensures exams are scheduled with proper patient class (make corrections when needed).
• Evaluates physician referral and authorization requirements to ensure requirements are met prior to date of service. Tracks accounts to resolution.
• Create cost estimates for scheduled appointments and send to patients.
• Answer questions on estimates as needed.
• Ensures that patients are aware of financial obligations, cost of care, access to financial education material.
• Counsels clinical staff and/or patients regarding benefit information when “out of network” situations arise or other potential carrier concerns
• Coordinates provider peer-to-peer appointments for applicable authorization denials.
• Documents pertinent information in system based upon department documentation standards.
• Assist patients sign up for copay assistance programs
• Assists with training new teammates.
• Maintains department productivity standards.
• Performs other related duties and projects as assigned

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: Entry Level
• Education Level: High school or GED