Insurance Authorization Verification Specialist III - Rev Cycle

We are looking for an Insurance Authorization Verifications Specialist III to join our Revenue Cycle team. In this role, you will manage the daily insurance eligibility and verification tasks for assigned providers, including confirming benefit details and securing authorizations or pre-certifications prior to patient visits or admissions, or immediately afterward. You will help identify and resolve issues, ensure insurance information is accurately reflected in patient accounts, and confirm that all necessary referrals are properly completed. Success in this position requires maintaining productivity levels, meeting UTHN-assigned performance metrics, and consistently demonstrating our team’s core values. We are a group passionate about creating positive patient experiences, and we seek a team member who shares our commitment to compassionate care. This position offers opportunities for continued growth and development within a comprehensive, multispecialty and university practices.

What we do here changes the world. UTHealth Houston is Texas’ resource for healthcare education, innovation, scientific discovery, and excellence in patient care. That’s where you come in.

Once you join us you won't want to leave. It’s because we reward our team for the excellent service they provide. Our total rewards package includes the benefits you’d expect from a top healthcare organization (benefits, insurance, etc.), plus:

• 100% paid medical premiums for our full-time employees
• Generous time off (holidays, preventative leave day, both vacation and sick time – all of which equates to around 37-38 days per year)
• The longer you stay, the more vacation you’ll accrue!
• Longevity Pay (Monthly payments after two years of service)
• Build your future with our awesome retirement/pension plan!

We take care of our employees! As a world-renowned institution, our employees’ wellbeing is important to us. We offer work/life services such as...

• Free financial and legal counseling
• Free mental health counseling services
• Gym membership discounts and access to wellness programs
• Other employee discounts including entertainment, car rentals, cell phones, etc.
• Resources for child and elder care
• Plus many more!

Position Summary:

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.

Certification/Skills:

• None

Minimum Education:

High School Diploma or equivalent requiredGraduate of an education program approved by the credentialing body for the required credential(s) requiredAssociate's Degree preferred

Minimum Experience:

5 years of medical office experience required with good understanding of third party reimbursement procedures requiredExperience in working with various insurance companies including both governmental and commercial insurance plans required

Physical Requirements:

Exerts up to 20 pounds of force occasionally and/or up to 10 pounds frequently and/or a negligible amount constantly to move objects.

Security Sensitive:

This position is a security-sensitive position pursuant to Texas Education Code §51.215 and Texas Government Code §411.094. To the extent that a position requires the holder to research, work on, or have access to critical infrastructure as defined in Texas Business and Commerce Code §117.001(2), the ability to maintain the security or integrity of the infrastructure is a minimum qualification to be hired for and to continue to be employed in that position. Personnel in such positions, and similarly situated state contractors, will be routinely reviewed to determine whether things such as criminal history or continuous connections to the government or political apparatus of a foreign adversary might prevent the applicant, employee, or contractor from being able to maintain the security or integrity of the infrastructure. A foreign adversary is a nation listed in 15 C.F.R. §791.4.

Residency Requirement:

Employees must permanently reside and work in the State of Texas.