Insurance Specialist II

About the role

The Department of Revenue Cycle - Ambulatory Patient Financial Services at UT Southwestern Medical Center is looking for an Insurance Specialist II to support the patient financial clearance process. The role covers insurance verification, benefit analysis, authorization and referral management, medical necessity review, financial clearance and assessment of patient financial responsibility. It works under general supervision, using payer guidelines and departmental policies to clear financial barriers before services are provided. The position is remote, Monday to Friday 7:30 a.m. to 4:30 p.m., and candidates must live in Texas (Dallas-Fort Worth preferred).

Key responsibilities

• Monitor the patient work queue to identify accounts needing verification.
• Pre-register patient cases in the EPIC ADT hospital billing system, verifying intake, insurance eligibility and pre-certification information with a 95% accuracy rate.
• Verify insurance coverage, deductibles and copays by using insurance websites or calling insurers.
• Enter and process prior authorizations, checking that they meet timelines and payer guidelines.
• Call patients to create cost estimates and explain out-of-network situations, following HIPAA.
• Coordinate with physicians' offices and ancillary departments to obtain pre-certification and benefits.
• Track cases to resolution and confirm that authorization codes match the services delivered.
• Maintain department productivity standards and document work according to department standards.

Required profile

• High school diploma or equivalent.
• 3 years of benefit verification/authorization experience or equivalent.
• 1 year of functional customer service experience.
• 3 years of functional clinical/medical experience in precertification, predetermination, authorizations or verification.
• 1 year of technical EPIC experience.

Required skills

• Microsoft Outlook and Microsoft Word (4 years each)
• Office equipment, fax and copier (4 years)
• EPIC (1 year)

What we offer

• PPO medical plan available day one at no cost for full-time employees
• 100% coverage for preventive care with no copay
• Paid time off and paid parental leave
• Retirement program through the Teacher Retirement System of Texas
• Tuition reimbursement and wellness programs