Role Description The Department of Revenue Cycle - Ambulatory Patient Financial Services has a new opportunity available for an Insurance Specialist II. This position is responsible for obtaining information to initiate verification and precertification process. The duties for this role will include but are not limited to the following: - Responsible for obtaining information to initiate verification and precertification process. - Fast paced role that requires good time management. - Ability to multi-task. - Utilize clear and concise documentation. - Understanding of insurance plans and how to review the payers’ medical policies. - This is a work from home position. Must live in Texas, DFW preferred. - Shift 7:30 am - 4:30 pm, Monday through Friday. Additional details to be discussed during the interview. Qualifications - High School diploma or equivalent. - 3 years of benefit verification/authorization experience or equivalent. - 1 year of Functional - Customer Service/Customer service. - 3 years of Functional - Clinical / Medical/Precertification/Predetermination/Authorizations/Verification. - 4 years of Technical - Desktop Tools/Microsoft Outlook. - 4 years of Technical - Desktop Tools/Microsoft Word. - 4 years of Technical - Office Equipment/Fax/Copier. - 1 year of Technical - EPIC. Requirements - 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. - Creates and calls patients with cost estimates 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 entry and processes authorizations and validates 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. - Confirms accuracy of scheduled procedure/s, observation, surgical observation and day surgery patients when converted to inpatient status. - Validates that authorization codes match the service delivered including following best practice to obtain 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, follows current policies and procedures and responds to administrative directives. - Enters accurately prior authorization data in accordance with established guidelines, including diagnosis of service and procedure codes. - Promotes team engagement. - Performs other related duties and projects as assigned. Benefits - 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.