Access Services Insurance Verification Specialist 2 (Prior Authorization)

About Us

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

Our Core Values are:

• We serve faithfully by doing what's right with a joyful heart.
• We never settle by constantly striving for better.
• We are in it together by supporting one another and those we serve.
• We make an impact by taking initiative and delivering exceptional experience.

Benefits

Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level.

Job Summary

The Insurance Verification Specialist 2 provides insurance benefit information to patients, physicians, and hospital staff. This role ensures timely insurance verification and financial clearance. It directly impacts the organization's reimbursement from payers for both scheduled and unscheduled patient accounts. This position also helps with complex issues and manages workflow.

Essential Functions of the Role

• Perform financial clearance of patient accounts by verifying insurance eligibility and benefits. Ensure all notifications and authorizations are completed on time.
• Completes appropriate payor forms related to notification and authorization.
• Coordinates the submission of clinical documentation from physicians to payers for authorization needs.
• Calculates accurate patient financial responsibility.
• Communicates promptly with Utilization Review. Partners effectively with physician and facility staff. Ensures financial clearance of the patient's account before any service during the hospital stay.
• Interprets complex payer coverage information, including network participation status, limited plan coverage, and inactive benefits.
• Assists co-workers, facility customers with complex questions and issues.
• Documents systems according to the Insurance Verification guidelines to assure accurate and timely reimbursement.
• Manages workflow of specific area to ensure maximum results for department as requested.

Key Success Factors

• 2 years of healthcare or customer service experience or education equivalency required.
• Must have the ability to consistently meet performance standards of production, accuracy, completeness and quality.
• Ability to know and adhere to payer guidelines by plan and service type.
• Requires good listening and communication skills, and professional telephone etiquette.
• Maintain a professional demeanor in stressful and emotional environments. Handle behavioral health and suffering patients, as well as life or death situations.
• Must exhibit high empathy and communicate well with patients and families during trauma. Demonstrate exceptional customer service skills.
• Demonstrates ability to manage multiple, changing priorities in an effective and organized manner.
• Excellent data entry, numeric, typing and computer navigational skills.
• Basic computer skills and Microsoft Office.

Belonging Statement

We believe that all people should feel welcomed, valued and supported.

QUALIFICATIONS

• EDUCATION - H.S. Diploma/GED Equivalent
• EXPERIENCE - 2 Years of Experience