Insurance Specialist II

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 is seeking a motivated and detail-oriented professional to join our team in a key role supporting the patient financial clearance process. This position performs specialized patient access and revenue cycle functions, including insurance verification, benefit analysis, authorization and referral management, medical necessity review, financial clearance, and assessment of patient financial responsibility. Under general supervision, this role uses established payer guidelines, departmental policies, and sound independent judgment to identify and resolve financial clearance barriers before services are provided. The position plays an important role in ensuring patients are financially prepared for their care while supporting accurate reimbursement, denial prevention, regulatory compliance, and a seamless patient financial experience. This is an excellent opportunity for someone who enjoys problem-solving, working collaboratively with clinical and operational teams, navigating complex payer requirements, and making a meaningful impact on both the patient experience and the organization's revenue cycle.

Additional Information

• This is a remote/work-from-home position.
• Candidates must reside in Texas; Dallas-Fort Worth (DFW) area preferred.

Schedule

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

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% 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 or equivalent

• Experience

3 years of benefit verification/authorization experience or equivalent and

1 year Functional - Customer Service/Customer service and

3 years Functional - Clinical / Medical/Precertification/Predetermination/Authorizations/Verification and

4 years Technical - Desktop Tools/Microsoft Outlook and

4 years Technical - Desktop Tools/Microsoft Word and

4 years Technical - Office Equipment/Fax/Copier and

1 year Technical-EPIC

JOB DUTIES

• 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 monitor, review, data entry and process 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.
• 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.

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.