Verify insurance eligibility, coverage, and benefits prior to patient appointments, manage documentation, and coordinate with teams to ensure accurate patient verification.
Responsibilities
Verify insurance eligibility, coverage, and benefits prior to patient appointments
Confirm out-of-network benefits, deductibles, coinsurance, and out-of-pocket maximums
Identify authorization, referral, and other insurance requirements
Review upcoming appointments to ensure patient demographics, insurance information, and required documentation are complete
Identify coverage discrepancies and communicate outstanding items to the appropriate teams
Responsible for initiating and managing pre-authorization requests for medical claims, ensuring compliance with payer requirements and maintaining accurate documentation.
Responsibilities
Initiate pre-authorization requests to payers
Communicate with payers, patients, physician offices, and hospital staff
Pre-certify procedures ordered by physicians
Monitor appropriateness and medical necessity
Provide necessary information for authorization and continued visits
Requirements
10 years of Revenue Cycle Experience in lieu of degree
A Managed Care Coordinator serves as the liaison between the Financial Counselor and the Utilization Management and Intake team by coordinating managed care review of benefits, authorizations, referrals and streamlining communication of the managed care components for patient services.
Compensation
Hiring Range: $20.87 - $29.02
Responsibilities
Monitor and coordinate internally and externally with the insurance company on the pre-certification and prior authorization processes, including peer-2-peer and appeals
Review assigned patient(s) and/or Physician schedules for upcoming visits and/or treatment to evaluate coverage criteria with payor guidelines and preferred treatment
Review patients’ treatment plan(s) and identify if insurance benefit coverage is active
Review and identify new treatment orders
Communicate openly and routinely throughout the course of the workday with various teams such as the Financial Counselor Team, Intake Team, UM team and coworkers through Teams, phone calls, emails and in person to discuss items as needed to complete managed cares
Learns and demonstrates proficiency in a minimum of one (1) of the following clinical front office operations: Patient Registration and Scheduling, Patient Access Call Center, Patient Arrival & Admitting, Patient Financial Services/Collections, Patient After Visit Scheduling, Medical Insurance Verification, Internal & External Referrals Management, Procedure Precertification & Authorization.
Compensation
Salary is commensurate with education, skills, and relevant experience.
Responsibilities
Learns and maintains up-to-date knowledge of the EPIC electronic medical record (EMR) system, front office clinical workflows and policies and procedures.
Delivers superior customer service, representing UT Southwestern in a positive and professional manner to patients, colleagues and the community.
Builds rapport and communication with internal and external team members to ensure best outcomes for the patient in a comprehensive clinical care model.
Maintains patient confidentiality in accordance with HIPAA and UT Southwestern policy.
Maintains neatness of customer waiting area; keeps area stocked with pamphlets and other materials as appropriate.
Provide administrative and front‑office support to the Medical Imaging Department, ensuring efficient daily operations and a positive patient experience.
Review, process, and audit chemotherapy regimens for medical necessity and obtain pre-certifications to ensure timely reimbursement.
Responsibilities
Reviews, processes and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence.
Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans.
Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs.
Updates coding/payer guidelines for clinical staff.
Tracks pathways and performs various other business office functions on an as needed basis.
Requirements
High school degree or equivalent
Associate degree in Healthcare, LPN state license and registration preferred
First line of customer service for patients and visitors entering the office, verifying insurance coverage and performing administrative tasks to support care delivery.
Compensation
This position pay ranges from $18.00-$24.00/hour
Responsibilities
Open and close the office daily
Greet and check-in patients as they arrive for their medical appointment
Verify demographic and insurance information, updating when necessary
Collect patient copays
Complete verification of medical benefits and obtain referrals and authorizations as required
Schedule, pre-certifies for both the physician and facility, verify insurance eligibility, review benefits and document procedure for Children's Hospital Operating Room and Ambulatory Surgery Center.
Compensation
$20.83 - $34.71
Responsibilities
Schedule and pre-certify for both physician and facility
Verify insurance eligibility and review benefits to include co-pay and deductible
Document procedure for Children's Hospital Operating Room and Ambulatory Surgery Center
Work with parents and other departments to schedule patients in a timely manner
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