Insurance Verification & Pre-Cert Specialist II

UT Southwestern Medical Center; Dallas (TX); On-site; USD 42,000 - 68,000; Full time

Benefits offered by this job

PPO medical plan

Paid Time Off

TRS Retirement

Paid Parental Leave

Wellness programs

Tuition Reimbursement

PSLF Qualified Employer

Job summary

UT Southwestern Medical Center in Dallas, TX, is seeking a detail-oriented Insurance/Billing professional to verify benefits, obtain precertifications, and manage patient eligibility. The role requires EPIC experience and strong collaboration with physician offices and ancillary departments to ensure timely, accurate authorizations.

You will handle patient pre-registration, verify insurance data, and process authorizations while maintaining HIPAA compliance and high-quality documentation in the

Qualifications

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

Responsibilities

• 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. Revises information in computer systems as needed.
• Documents pertinent information and efforts in computer system based upon department documentation standards.
• 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.
• Create and call 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 enters and processes authorizations and validate that the requests are accurate, within the required timeline, and in compliance with the applicable insurance guidelines
• Follows strict quality measures of documents scanned into the electronic medical record and/or submitted to applicable insurance
• Protects the privacy and security of patient health information to ensure that confidentiality is maintained
• Counsels offices and/or patients when an out of network situation becomes apparent or other potential payor technicalities arise. Coordinates as needed with other departments/ancillary areas for special needs or resources.
• Verifies insurance coverage and eligibility for all applicable scheduled services specific to the type of 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. Tracks cases to resolution
• 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
• Pre-Registers patient cases by entering complete and accurate information in EPIC ADT hospital billing system prior to the patient's arrival. 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. Accurately revises information in computer systems as needed. Documents pertinent information and efforts in computer system based upon department documentation standards.
• 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 obtained revised authorization for codes that are changed and have been communicated timely through proper channels.
• Contacts patient as appropriate to collect critical information and/or to advise of benefits information and

Education

High School diploma or equivalent

Job description

UT Southwestern Medical Center in Dallas, TX, is seeking a detail-oriented Insurance/Billing professional to verify benefits, obtain precertifications, and manage patient eligibility. The role requires EPIC experience and strong collaboration with physician offices and ancillary departments to ensure timely, accurate authorizations.

You will handle patient pre-registration, verify insurance data, and process authorizations while maintaining HIPAA compliance and high-quality documentation in the