An Eligibility Specialist provides assistance and information for people who apply for a government benefits program or health care program. Answers questions, assists with an application process, and reviews applications and relevant background information to determine eligibility. May assist eligible applicants with enrolling in a program.
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!
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 Customer Service/Customer service and 3 years Clinical / Medical/Precertification/Predetermination/Authorizations/Verification and 4 years end user Desktop Tools, Microsoft Outlook, Microsoft Word, Office Equipment/Fax/Copier and 1 year of EPIC experience.
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 monitors, reviews, data enters and processes 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. Performs other duties as assigned. 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.
