Senior Insurance Authorization Verification Specialist
Works to achieve team and departmental goals by serving as a team lead for the Insurance Verification team responsible for verifying insurance policy benefit information and obtaining Authorization / Precertification, prior to the patient’s visit or scheduled admission, or immediately following admission. Identifies problems and ensures that the insurance is accurate on the patient account. Assures insurance information and appropriate referrals have been completely and accurately obtained.
Position Key Accountabilities:
- Verifies insurance policy benefits for new and returning patients with carriers and employers.
- Assures all insurance information has been completely and accurately obtained. Documents all pertinent insurance information. Documents information given or received to support actions taken on insurance charges or referral issues.
- Identifies complex special policy clauses or pre-existing conditions and verifies effective date of policies.
- Mentors and serves as a resource for less experienced staff.
- Educates patients and families on insurance issues. Communicates patient’s fiscal responsibility in a professional manner.
- Ensures that accurate notification of patient’s insurance coverage, authorizations, or status is provided to all involved work units and departments.
- Identifies all patients without third party financial benefits and directs them for financial counseling according to Financial Counseling and Revenue Cycle policies and procedures.
- Receives and reviews UT-H Health Science Center’ Managed Care contracts to understand the contract provisions. Interprets managed care contracts for insurance coverage.
- Provides support to Revenue Cycle work units and other work units as assigned.
- Performs other duties as assigned.
- Bilingual preferred
Excellent communication skills, both oral and written.
Understanding of MS Office applications with an emphasis in Excel. Good math and basic clerical skills.
Proven ability to effectively problem solve.
Must have skill in establishing and maintaining effective working relationships with other employees, patients, governmental and commercial payer representatives.
High school or equivalent required. Graduate from a vocational business school in job related field or an Associate’s Degree preferred.
Five (5) years medical office experience required with good understanding of third party reimbursement procedures. Must have experience in working with various insurance companies including both governmental and commercial insurance plans.
Exerts up to 20 pounds of force occasionally and/or up to 10 pounds frequently and/or a negligible amount constantly to move objects.
This job class may contain positions that are security sensitive and thereby subject to the provisions of Texas Education Code § 51.215
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