Insurance Verification Specialist

NACBA; Dallas, Northern (TX, KY); Hybrid; USD 42,000 - 52,000; Full time

Benefits offered by this job

Immediate health benefits eligibility

401(k) with 5% match

Tuition Reimbursement

PTO from Day 1

Job summary

Baylor Scott & White Health is seeking an Insurance Verification Specialist 1 to provide insurance benefit information to patients, physicians, and hospital staff and to ensure timely verification and financial clearance for services.

Under general supervision, you will determine patient financial responsibility, coordinate with payers, and support the reimbursement process. This role requires attention to payer guidelines and strong data entry and communication skills.

Qualifications

• Education: HS Diploma or GED.
• Experience: Less than 1 year in healthcare or customer service preferred.

Responsibilities

• Verify insurance eligibility and benefits to determine financial clearance before services.
• Complete payor forms related to notifications and authorizations.
• Coordinate submission of clinical documents from physicians to payers for authorization.
• Calculate patient financial responsibility.
• Communicate with Utilization Review and collaborate with physicians and staff to ensure clearance before services.
• Interpret payer coverage, network participation, and benefits limitations.
• Document systems per Insurance Verification guidelines to ensure timely reimbursement.

Skills

Customer service

Data entry

Communication skills

Telephone etiquette

Microsoft Office

Education

HS Diploma/GED

Tools

Microsoft Office

Job description

About Us Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

Our Core Values are:

• We serve faithfully by doing what's right with a joyful heart.
• We never settle by constantly striving for better.
• We are in it together by supporting one another and those we serve.
• We make an impact by taking initiative and delivering exceptional experience.

Benefits

Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level.

Job Summary

The Insurance Verification Specialist 1, under general supervision, provides insurance benefit information to patients, physicians, and hospital staff. This position ensures timely insurance verification and financial clearance. This directly impacts the organization's reimbursement from payers for both scheduled and unscheduled patient accounts.

Essential Functions of the Role

• Perform financial clearance of patient accounts by verifying insurance eligibility and benefits. Ensure all notifications and authorizations are completed on time.
• Completes appropriate payor forms related to notification and authorization.
• Coordinates the submission of clinical documentation from physicians to payers for authorization needs.
• Calculates accurate patient financial responsibility.
• Communicates promptly with Utilization Review. Collaborates effectively with the physician and facility staff. Ensures financial clearance of the patient's account before any service during the hospital stay.
• Interprets complex payer coverage information, including network participation status, limited plan coverage, and inactive benefits.
• Documents systems according to the Insurance Verification guidelines to assure accurate and timely reimbursement.

Key Success Factors

• 1 year of healthcare or customer service experience preferred.
• Must have the ability to consistently meet performance standards of production, accuracy, completeness and quality.
• Ability to understand and adhere to payer guidelines by plan and service type.
• Requires good listening, interpersonal and communication skills, and professional, pleasant and respectful telephone etiquette.
• Maintain a professional demeanor in stressful and emotional environments. Handle behavioral health and suffering patients, including life or death situations.
• Must exhibit high empathy and communicate well with patients and families during traumatic events. Demonstrate exceptional customer service skills.
• Demonstrates ability to manage multiple, changing priorities in an effective and organized manner.
• Excellent data entry, numeric, typing and computer navigational skills. Basic computer skills and Microsoft Office.

Belonging Statement

We believe that all people should feel welcomed, valued and supported.

QUALIFICATIONS

• EDUCATION - H.S. Diploma/GED Equivalent
• EXPERIENCE - Less than 1 Year of Experience