Insurance Specialist III

WHY UT SOUTHWESTERN?
With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you'll discover a culture of teamwork, professionalism, and a rewarding career! 

JOB SUMMARY
The Department of Revenue Cycle – Ambulatory Patient Financial Services has an exciting opportunity for a role that, under moderate supervision, supervision to be 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, and 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. 

BENEFITS
UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100%25 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
• Learn more about these and other UTSW employee benefits!

EXPERIENCE AND EDUCATION

Required

• Education
  High School Diploma 
   

• Experience
  4 years 4-6 years of benefit verification/authorization experience or equivalent and 
  1 year 1-3 years Functional - Working remotely and 
  2 years 2-5 years Functional - Customer Service/Customer service and 
  4 years 4-6 years Functional - Clinical/Medical/Precertification/Predetermination/Authorizations/Verification and 
  4 years 4-6 years Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User and 
  4 years 4-6 years Technical - Desktop Tools/Microsoft Word/4-6 Years/End User and 
  4 years 4-6 years Technical - Office Equipment/Fax/Copier/4-6 Years/End User 
   

• Licenses and Certifications
  (CHAA) CERT HEALTHCARE ACCESS ASSOC NAHAM required within 1 year of hire or promotion. within 1 Year 
   

JOB DUTIES

• Monitors patient and/or referral work queues to determine encounters that require pre-registration, verification, authorization, or corrections to ensure proper billing.
• Pre-registers patient cases by entering complete and accurate information in the hospital billing system prior to patient's arrival. Identifies and verifies all essential information pertaining to intake, guarantor, subscriber, insurance verification/eligibility, and precertification on complex and specialized patient accounts. Revises information in computer systems as needed.
• Coordinate with financial counselor, clinic, and patient or other appropriate party to identify special billing and additional information needed to secure accurate billing and/or patient financial responsibility.
• Verifies insurance coverage and eligibility for all applicable scheduled services specific to the type of appointment, procedure and/or exam, and site of service. Evaluates physician referral and authorization requirements and takes appropriate steps to ensure requirements are met prior to date of procedure.
• Ensures all appointments and/or procedures are scheduled with proper patient class and clinical indicators and coding nomenclature.
• Reviews and verifies insurance information by utilizing various methods to verify eligibility, gather a full benefit profile, authorization requirements, and any other specific information needed in accordance to the verification guidelines.
• Coordinates with patient, referring physician's office and/or referring location, scheduled service area, financial counselors, case manager, and others as appropriate to obtain additional information or provide information on patients financial status.
• Coordinates as needed with other departments/ancillary areas for special needs or resources.
• Counsels clinical partners and/or patients to advice of benefits information when "out of network" situations become apparent or other potential payor technicalities arise.
• Reviews clinical documentation for CPT/diagnosis code information to support authorization / precertification according to payer guidelines.
• Accurately monitors, reviews, data enters and processes authorizations and validate that the requests are accurate, within the required timeline, and in compliance with the applicable insurance guidelines.
• Ensures that patient is aware of financial obligations, cost of care, access to financial education material, and appropriate financial acknowledgement documents are prepared and/or signed.
• Documents pertinent information and efforts in computer system based upon department documentation standards.
• Maintains department productivity standards.
• Protects the privacy and security of patient health information to ensure that confidentiality is maintained.
• Pre-registers patient cases by entering complete and accurate information in the hospital billing system prior to patient's arrival. Identifies and verifies all essential information pertaining to intake, guarantor, subscriber, insurance verification/eligibility, and precertification on all applicable patient accounts. Revises information in computer systems as needed. Revising information as needed. Documenting pertinent information and efforts in the computer system with a 95%25 accuracy rate.
• Confirms accuracy of scheduled procedure/s, re-verifies emergency room, 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 obtained revised authorization for codes that are changed and have been communicated timely through proper channels.
• Recommends creation of new policies/SOPs and updates to existing policies/SOPs. Assist in the development and implementation of new and revised policies/SOPs.
• Makes recommendations for changes in procedure to increase productivity and accuracy.
• Performs and monitors special projects in order to meet turnaround times, production standards, and project deadlines.
• Provides support to junior level Insurance Specialists.
• Contributes to the development of the onboarding and training program for Insurance Specialist.
• Services as the first line of escalation in the event of a patient service failure.
• Functions as a "superuser" for new software applications or upgrades in existing applications and assists in training of assigned team member.
• Demonstrates ongoing competency skills including above level problem solving skills and decision- making abilities.
• Maintains strictest confidentiality in accordance to policies and HIPAA guidelines.
• Promotes team engagement.
• Fosters in building a cooperative, supportive, productive, and efficient team that while serving as a mentor.
• Cultivates a shared vision for the department that is consistent with the UTSW vision and strategic initiatives. Upholds the departmental leadership, expectations, customer services, professionalism, standards, processes, and other departmental strategies.
• Duties performed may include one or more of the following core functions: (a) directly interacting with or caring for patients; (b) directly interacting with or caring for human-subjects research participants; (c) Regularly maintaining modifying, releasing or similarly affecting patient records (including patient financial records); or (d) regularly maintaining, modifying releasing, or similarly affecting human-subjects research records.
• Performs other related duties and projects as assigned. This job description should not be considered an exhaustive listing of all duties and responsibilities performed in this position. Our practice encourages all employees to develop personal and professional goals for themselves and will provide opportunities for continued growth and development.

SECURITY AND EEO STATEMENT

Security
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

EEO
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.