[Hiring] Insurance Specialist II @UT Southwestern Medical Center

Role Description

The Department of Revenue Cycle – Ambulatory Patient Financial Services is seeking a motivated and detail-oriented professional to join our team in a key role supporting the patient financial clearance process. This position performs specialized patient access and revenue cycle functions, including:

• Insurance verification
• Benefit analysis
• Authorization and referral management
• Medical necessity review
• Financial clearance
• Assessment of patient financial responsibility

Under general supervision, this role uses established payer guidelines, departmental policies, and sound independent judgment to identify and resolve financial clearance barriers before services are provided. The position plays an important role in ensuring patients are financially prepared for their care while supporting:

• Accurate reimbursement
• Denial prevention
• Regulatory compliance
• A seamless patient financial experience

This is an excellent opportunity for someone who enjoys problem-solving, working collaboratively with clinical and operational teams, navigating complex payer requirements, and making a meaningful impact on both the patient experience and the organization's revenue cycle.

Additional Information:

• This is a remote/work-from-home position.
• Candidates must reside in Texas; Dallas-Fort Worth (DFW) area preferred.
• Schedule: Monday through Friday, 7:30 a.m. – 4:30 p.m. Additional details will be discussed during the interview process.

Qualifications

• High School diploma or equivalent
• 3 years of benefit verification/authorization experience or equivalent
• 1 year in Functional - Customer Service/Customer service
• 3 years in Functional - Clinical / Medical/Precertification/Predetermination/Authorizations/Verification
• 4 years in Technical - Desktop Tools/Microsoft Outlook
• 4 years in Technical - Desktop Tools/Microsoft Word
• 4 years in Technical - Office Equipment/Fax/Copier
• 1 year in Technical - EPIC

Requirements

• 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's arrival.
• Identifies and verifies all essential information pertaining to intake, insurance verification/eligibility, and precertification on all applicable patient accounts.
• Documents pertinent information and efforts in computer system based upon department documentation standards.
• Verifies insurance information by utilizing insurance websites or calling insurance companies.
• Creates and calls patients with cost estimate for scheduled appointments.
• Ensures all exams are scheduled with proper patient class and clinical indicators and coding nomenclature.
• Monitors, verifies, transcribes faxed documents to select insurance companies regarding authorization requests.
• Accurately monitors, reviews, data entry and processes authorizations.
• Follows strict quality measures of documents scanned into the electronic medical record.
• Protects the privacy and security of patient health information.
• Counsels' offices and/or patients when an out of network situation becomes apparent.
• Coordinates with case management, physician's office and/or ancillary department regarding any additional information needed.
• Confirms accuracy of scheduled procedure/s, observation, surgical observation and day surgery patients.
• Contacts patient as appropriate to collect critical information and/or to advise of benefits information.
• Demonstrates ongoing competency skills including above level problem solving skills and decision-making abilities.
• Maintains the strictest confidentiality in accordance to policies and HIPAA guidelines.
• Enters accurately prior authorization data in accordance with established guidelines.
• Promotes team engagement.
• 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% 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