[Hiring] Insurance Specialist III @UT Southwestern Medical Center

Role Description

The Department of Revenue Cycle – Ambulatory Patient Financial Services has an exciting opportunity for a role that, under moderate supervision, is responsible for pre-registration, insurance verification, eligibility, authorization, and front-end revenue cycle operations to ensure proper billing and pleasant patient financial experience. Responsibilities include:

• Managing escalated payer issues and complex authorization cases.
• Interpreting advanced payer policies.
• Supporting workflow improvements.
• Mentoring and training staff.
• Serving as a subject matter expert.

Schedule: Monday through Friday, 7:30 a.m. – 4:30 p.m. Additional details will be discussed during the interview process.

Work from home: Candidates can work from home. Preferred applicants live in the Greater DFW area.

Qualifications

• High School Diploma.
• 4-6 years of benefit verification/authorization experience or equivalent.
• 1-3 years of functional experience working remotely.
• 2-5 years of customer service experience.
• 4-6 years of clinical/medical/precertification/predetermination/authorizations/verification experience.
• 4-6 years of technical experience with desktop tools (Microsoft Outlook, Microsoft Word).
• 4-6 years of experience with office equipment (Fax, Copier).
• (CHAA) CERT HEALTHCARE ACCESS ASSOC NAHAM required within 1 year of hire or promotion.

Requirements

• Monitors patient and/or referral work queues to determine encounters that require pre-registration, verification, authorization, or corrections.
• Pre-registers patient cases by entering complete and accurate information in the hospital billing system prior to patient's arrival.
• Coordinates with financial counselor, clinic, and patient to identify special billing and additional information needed.
• Verifies insurance coverage and eligibility for all applicable scheduled services.
• Ensures all appointments and/or procedures are scheduled with proper patient class and clinical indicators.
• Reviews and verifies insurance information utilizing various methods.
• Coordinates with patient, referring physician's office, and others as appropriate to obtain additional information.
• Counsels clinical partners and/or patients on benefits information when "out of network" situations arise.
• Reviews clinical documentation for CPT/diagnosis code information to support authorization/precertification.
• Accurately monitors, reviews, data enters, and processes authorizations.
• Ensures that patient is aware of financial obligations and prepares appropriate financial acknowledgment documents.
• Documents pertinent information and efforts in the computer system.
• Maintains department productivity standards.
• Protects the privacy and security of patient health information.
• Confirms accuracy of scheduled procedures and validates authorization codes.
• Recommends creation of new policies/SOPs and updates to existing policies/SOPs.
• Provides support to junior level Insurance Specialists.
• Serves as the first line of escalation in the event of a patient service failure.
• Functions as a "superuser" for new software applications or upgrades.
• Maintains strictest confidentiality in accordance with policies and HIPAA guidelines.
• Promotes team engagement and fosters a cooperative team environment.
• 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.