INSURANCE SPECIALIST II

Job Description - INSURANCE SPECIALIST II (947961) Overview INSURANCE SPECIALIST II – responsible for benefit verification, pre-certification, and authorization services for patients within UT Southwestern in Dallas, Texas. Benefits PPO medical plan, available day one at no cost for full‑time employee‑only coverage 100% 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 Experience and Education Education: High School diploma or equivalent. Experience: 3 years benefit verification/authorization experience or equivalent; 1 year customer service; 3 years clinical/medical/precertification/predetermination/authorizations/verification; 4 years end‑user desktop tools, Microsoft Outlook, Microsoft Word, Office equipment/fax/copier; 1 year EPIC experience. 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 arrival. Identifies and verifies all essential intake, insurance verification/eligibility, and pre‑certification data on applicable patient accounts; revises information in computer systems as needed. Documents pertinent information and efforts in the 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 other specific details in accordance with verification guidelines. Creates and calls patients with cost estimates for scheduled appointments. Ensures all exams are scheduled with proper patient class and clinical indicators and coding nomenclature. Monitors, verifies, and transcribes faxed documents to selected insurance companies regarding authorization requests. Accurately monitors, reviews, data‑enters, and processes authorizations, validating that the requests are accurate, within the required timeline, and in compliance with applicable insurance guidelines. Follows strict quality measures for documents scanned into the electronic medical record or submitted to applicable insurance. Protects the privacy and security of patient health information to ensure confidentiality. Counsels offices and/or patients when an out‑of‑network situation becomes apparent or other payor technicalities arise; coordinates with other departments as needed for special resources. Verifies insurance coverage and eligibility for all scheduled services specific to the type of procedure and/or exam, and site of service. Evaluates physician referral and authorization requirements and ensures 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 to obtain pre‑certification and insurance benefits. Pre‑registers patient cases in EPIC ADT hospital billing system; ensures a 95% accuracy rate; revises information in computer systems as needed; documents work in the system per department standards. Confirms accuracy of scheduled procedures for observation, surgical observation, and day‑surgery patients when converted to inpatient status; validates that authorization codes match delivered service and obtains revised authorization for changed codes in a timely manner. Contacts patients as appropriate to collect critical information and advise on benefits and “out of network” situations; coordinates with financial counselor or other personnel per customer satisfaction guidelines and HIPAA compliance. Performs other duties as assigned, demonstrates ongoing competency skills, problem‑solving, decision‑making, and maintains strict confidentiality per policies and HIPAA guidelines. Responds to administrative directives and promotes team engagement; enters prior authorization data in accordance with established guidelines, including diagnosis and procedure codes. Performs related duties and projects as assigned; this description is not exhaustive and encourages professional growth. Security and EEO Statement 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 and harassment on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status. #J-18808-Ljbffr The University of Texas Southwestern Medical Center