Reimbursement Specialist - Ophthalmology Insurance/Auth

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
Works under moderate supervision to provide policy analysis and recommendations to management related to reimbursement projects and functions. 

 

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%25 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
  4 years of progressively responsible experience in medical insurance, medical billing or medical reimbursement. 
   

Preferred

• Licenses and Certifications
  (CPC) CERT PROFESSIONAL CODER Upon Hire or
  Advanced Records Technician (ART) Upon Hire or
  (RRA) REGISTERED RECORDS ADMIN Upon Hire 
   

JOB DUTIES

• Performs insurance verification/eligibility and completes precertification on all applicable patient accounts.
  • Identifies and verifies essential information pertaining to guarantor/subscriber.
  • Monitors patient work queues/DAR to review accounts that require estimates, verification and/or authorization.
    • Reviews clinical documentation for CPT/diagnosis code information to support authorizations according to carrier guidelines.
  • Verifies patient insurance benefits and eligibility for all applicable scheduled services specific to the type of appointment, procedure and/or exam, and site of service via carrier websites or calling insurance companies.
  • Address and resolve plan alerts/errors and insurance filing order discrepancies.
• Ensures exams are scheduled with proper patient class (make corrections when needed).
• Evaluates physician referral and authorization requirements to ensure requirements are met prior to date of service. Tracks accounts to resolution.
• Create cost estimates for scheduled appointments and send to patients.
  • Answer questions on estimates as needed.
  • Ensures that patients are aware of financial obligations, cost of care, access to financial education material.
• Counsels clinical staff and/or patients regarding benefit information when “out of network” situations arise or other potential carrier concerns
• Coordinates provider peer-to-peer appointments for applicable authorization denials.
• Documents pertinent information in system based upon department documentation standards.
• Assist patients sign up for copay assistance programs
• Assists with training new teammates.
• Maintains department productivity standards.
• Performs other related duties and projects as assigned

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.