Insurance Specialist I - Pre-Arrival Fin Svcs

About the position

UT Southwestern Medical Center is seeking an Insurance Specialist I to join the Pre-Arrival Financial Services Department. This position offers the flexibility of working from home or in the office, depending on mutual agreement with the supervisor. The training period will take place on campus and is expected to last between sixty to ninety days. After training, employees may choose to work from home, provided they reside within the Greater Dallas-Fort Worth area. The role involves an 8-hour workday from Monday to Friday, contributing to a dynamic team dedicated to providing exceptional healthcare services. As a world-renowned medical and research center, UT Southwestern has a rich history of over 75 years in excellence, innovation, teamwork, and compassion. The organization is committed to delivering the best possible care and resources for both patients and employees. With a workforce exceeding 20,000, UT Southwestern is focused on growth and seeks to attract the best professionals in the healthcare industry. The Insurance Specialist I will play a crucial role in ensuring that patients receive the necessary insurance verification and pre-certification for their medical services, thereby facilitating a smooth patient experience. The ideal candidate will be responsible for monitoring patient work queues, coordinating with physician offices for additional information, and maintaining productivity standards. They will pre-register patient cases, verify insurance information, and document all relevant details in the electronic medical record system. The role requires effective communication with patients and medical professionals to ensure that all necessary authorizations are obtained in a timely manner. The Insurance Specialist I will also be expected to adhere to HIPAA guidelines and maintain the confidentiality of patient information throughout their work.

Responsibilities
? Monitors the correct patient work queue to determine accounts needing verification.
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? Coordinates with physician's office and/or ancillary department regarding additional information needed to obtain pre-certification and insurance benefits.
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? Maintains department productivity standards.
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? Pre-registers patient cases by entering complete and accurate information prior to patient's arrival.
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? Identifies and verifies all essential information pertaining to intake, insurance verification/eligibility, and precertification on all applicable patient accounts.
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? Revises information in computer systems as needed.
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? Documents pertinent information and efforts in computer system based upon department documentation standards.
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? 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.
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? Creates and calls patients with cost estimates for scheduled appointments.
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? Ensures all exams are scheduled with proper patient class and clinical indicators and coding nomenclature.
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? Monitors, verifies, transcribes faxed documents to select insurance companies regarding authorization requests.
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? Accurately monitors, reviews, data enters and processes authorizations and validates that the requests are accurate, within the required timeline, and in compliance with the applicable insurance guidelines.
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? Signs into and answers the assigned ACD line, documenting patient accounts per documentation expectations.
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? Follows strict quality measures of documents scanned into the electronic medical record and/or submitted to applicable insurance.
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? Protects the privacy and security of patient health information to ensure that confidentiality is maintained.
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? Counsels offices and/or patients when an out of network situation becomes apparent or other potential payor technicalities arise.
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? Coordinates as needed with other departments/ancillary areas for special needs or resources.
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? Verifies insurance coverage and eligibility for all applicable scheduled services specific to the type of procedure and/or exam, and site of service.
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? Evaluates physician referral and authorization requirements and takes appropriate steps to ensure requirements are met prior to date of procedure.
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? Tracks cases to resolution.
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? 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.
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? Pre-registers patient cases by entering complete and accurate information in EPIC ADT hospital billing system prior to the patient's arrival.
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? Identifies/obtains/verifies all essential information pertaining to intake, insurance verification/eligibility and pre-certification on all applicable patients accounts with a 95% accuracy rate.
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? 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 obtain revised authorization for codes that are changed and have been communicated timely through proper channels.
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? Contacts patient as appropriate to collect critical information and/or to advise of benefits information and 'out of network' situations.
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? Coordinates with the financial counselor or other entity as appropriate and per customer satisfaction guidelines.
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? Adheres to HIPAA guidelines when contacting patient.
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? Performs other duties as assigned.

Requirements
? High school diploma or GED required.
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? Two (2) to four (4) years of benefit verification/authorization experience or equivalent required.
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? Proficiency in Microsoft Word and Outlook.
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? Experience with Medicare, Medicaid, and commercial insurance verification/authorization.
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? Strong customer service skills and ability to interact with medical professionals.

Nice-to-haves
? Experience working with high schoolers.
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? Familiarity with Epic systems.

Benefits
? Paid parental leave
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? Health insurance
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? Tuition reimbursement
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? Paid time off
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? Work from home options
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? Loan forgiveness programs

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