Insurance Verification & Precertification Specialist

UTSW; Dallas (TX); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

PPO medical plan

100% preventive care coverage

Paid Time Off

Retirement Programs

Paid Parental Leave

Wellness programs

Tuition Reimbursement

PSLF Qualified Employer

Job summary

UT Southwestern Medical Center in Dallas is seeking an experienced Benefits Verification/Pre-certification Specialist to verify patient eligibility, coordinate with providers, and prepare accurate pre-certification data in the EPIC system.

You will ensure accurate insurance verification, collect cost estimates, and schedule patient exams while maintaining HIPAA privacy and pursuing timely authorizations. A strong focus on accuracy and customer service is essential for success.

Qualifications

• High School diploma or equivalent.
• 3 years of benefit verification/authorization experience or equivalent and 1 year in Customer Service.
• 3 years in Clinical/Medical/Precertification/Predetermination/Authorizations/Verification.
• 4 years end-user desktop tools experience (Outlook, Word, etc.).
• 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.
• 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 “out of network” situations. Coordinates with the financial counselor or other entity as appropriate and per customer satisfaction guidelines. Adheres to HIPAA guidelines when contacting patient.
• Performs other duties as assigned.
• 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
• With general oversight follow our current policies and procedures and responds to administrative directives.
• Enters accurately prior authorization data and in accordance with established guidelines, including diagnosis of service and procedure codes.
• Promotes team engagement
• 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.

Skills

Customer service

Attention to detail

Communication

Education

High School diploma or equivalent

Tools

EPIC

Microsoft Outlook

Microsoft Word

Office Equipment/Fax/Copier

Job description

UT Southwestern Medical Center in Dallas is seeking an experienced Benefits Verification/Pre-certification Specialist to verify patient eligibility, coordinate with providers, and prepare accurate pre-certification data in the EPIC system.

You will ensure accurate insurance verification, collect cost estimates, and schedule patient exams while maintaining HIPAA privacy and pursuing timely authorizations. A strong focus on accuracy and customer service is essential for success.