Insurance And Pre-Authorization Specialist (Full-Time) (NW Houston) (11903-147)

United Surgical Partners International Houston , TX 77020

Posted 2 months ago

TOPS Hospital has served the North Houston community for more than 30 years and recently underwent a major expansion and renovation project that included all new operating room suites as well as updated patient care and public areas.

Responsible for completing insurance verification on all new cases, as well as ensuring that all assigned cases contain complete and accurate demographic and financial information. It is the responsibility of the Verification Representative to determine the primary and secondary (if any) payer.

Knowledge of how managed care plans work and possess the ability to calculate expected reimbursement. This includes determining the payer source as an HMO, PPO, POS, EPO, HIX plan, and knowing the requirements of admission notification, authorization, and continuing utilization review. Also required is detailed payment methodology knowledge of commercial insurance, and Medicare.

This includes the ability to identify non-covered services. Determines patient responsibility based on insurance contract and the patient's policy limitations. The Verification Representative documents all actions taken on each account.

The Verification Representative often times has direct contact with other physician office staff, patients, hospital departments as well as insurance companies; therefore, this position requires a candidate whom demonstrates a positive demeanor, good verbal and written communication skills, and is professional in both appearance and approach. The employee must demonstrate strong interpersonal and persuasive abilities in order to secure accurate and timely payment from patients. The incumbent is responsible for ensuring that the facility's financial viability is secured at the most basic level by securing accurate and timely payments.

Any errors may result in a delay or loss of reimbursement. Candidate must be able to handle potentially stressful situations and handle multiple tasks at one time. He/she must be a positive role model for other staff members and patients by working with them to promote teamwork and cooperation.

Candidate must be able to accept constructive criticism and integrate suggestions in effective ways. As a member of the facility's team, this person must comply with United Surgical Partner's International's policies and procedures

Required Skills

High School Diploma

MUST have two or more years of experience in hospital insurance verification.

Able to flex hours and work days to meet needs related to unanticipated acuity, volume changes or problems.

Excellent communication skills.

Exercises good judgment in handling accounts, knowledge of patient account components, knowledge of third party payors and managed care payment guidelines and verification requirements. Must possess good analytical skills to decipher patients' limitations of coverage.

Must have the ability to multi-task. Interpretation of complex and numerous managed care contracts is required. Typing, data entry, 10-key. Knowledge of PC spreadsheets and processing skills

Required Experience

Must have two or more years of experience in hospital insurance verification.



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Insurance And Pre-Authorization Specialist (Full-Time) (NW Houston) (11903-147)

United Surgical Partners International