Insurance Verification Specialist I - Prior Authorization & Infusion Services

Insurance Verification Specialist 1

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

Our Core Values are:

• We serve faithfully by doing what's right with a joyful heart.
• We never settle by constantly striving for better.
• We are in it together by supporting one another and those we serve.
• We make an impact by taking initiative and delivering exceptional experience.

The Insurance Verification Specialist 1, under general supervision, provides insurance benefit information to patients, physicians, and hospital staff. This position ensures timely insurance verification and financial clearance. This directly impacts the organization's reimbursement from payers for both scheduled and unscheduled patient accounts.

Essential Functions of the Role:

• Perform financial clearance of patient accounts by verifying insurance eligibility and benefits. Ensure all notifications and authorizations are completed on time.
• Completes appropriate payor forms related to notification and authorization.
• Coordinates the submission of clinical documentation from physicians to payers for authorization needs.
• Calculates accurate patient financial responsibility.
• Communicates promptly with Utilization Review. Collaborates effectively with the physician and facility staff. Ensures financial clearance of the patient's account before any service during the hospital stay.
• Interprets complex payer coverage information, including network participation status, limited plan coverage, and inactive benefits.
• Documents systems according to the Insurance Verification guidelines to assure accurate and timely reimbursement.

Key Success Factors:

• 1 year of healthcare or customer service experience preferred.
• Must have the ability to consistently meet performance standards of production, accuracy, completeness and quality.
• Ability to understand and adhere to payer guidelines by plan and service type.
• Requires good listening, interpersonal and communication skills, and professional, pleasant and respectful telephone etiquette.
• Maintain a professional demeanor in stressful and emotional environments. Handle behavioral health and suffering patients, including life or death situations.
• Must exhibit high empathy and communicate well with patients and families during traumatic events. Demonstrate exceptional customer service skills.
• Demonstrates ability to manage multiple, changing priorities in an effective and organized manner.
• Excellent data entry, numeric, typing and computer navigational skills. Basic computer skills and Microsoft Office.
• Manage insurance verification and prior authorization activities for infusion therapy patients, ensuring timely approvals for new starts and ongoing treatment renewals.
• Coordinate patient enrollment and administration of copay assistance and patient assistance programs to help reduce out-of-pocket treatment costs.
• Review claims, EOBs, reimbursement trends, and revenue collection activities related to infusion services to help ensure accurate payment and identify reimbursement variances.
• Bilingual (Spanish/English) preferred.

We believe that all people should feel welcomed, valued and supported.

Qualifications:

• Education - H.S. Diploma/GED Equivalent
• Experience - Less than 1 Year of Experience