Insurance Verification Specialist 2 - Prior Authorization (Hybrid - Dallas)

Insurance Verification Specialist 2

The Insurance Verification Specialist 2 provides insurance benefit information to patients, physicians, and hospital staff. This position ensures timely insurance verification and financial clearance. It directly impacts the organization's reimbursement from payers for scheduled and unscheduled patient accounts. This position also helps with complex issues and manages workflow.

Essential Functions of the Role:

• Perform financial clearance of patient accounts by verifying insurance eligibility and benefits. Ensure all notifications and authorizations are completed within the required timeframe.
• 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 with the physician and staff to ensure financial clearance before the patient's service.
• Interprets complex payer coverage information, including network participation status, limited plan coverage, and inactive benefits.
• Assists co-workers and facility customers with complex questions and issues.
• Documents systems according to the Insurance Verification guidelines to assure accurate and timely reimbursement.
• Manages workflow of specific area to ensure maximum results for department as requested.

Key Success Factors:

• 2 years of healthcare or customer service experience or education equivalency required.
• 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, emotional environments with behavioral health or suffering patients, and life or death situations.
• Must exhibit high empathy and communicate well with patients and families during trauma. 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.

Qualifications:

• EDUCATION - H.S. Diploma/GED Equivalent
• EXPERIENCE - 3 Years of Experience