Houston Methodist Sr Insurance Verifier - FT/Days (Medical Center) in Houston, Texas
At Houston Methodist, the Senior Insurance Verifier position is responsible for obtaining and recording eligibility and benefit information for patients receiving services and initiates the admission notification and authorization process in a timely manner. The Senior Insurance Verifier communicates to resolve patient access and quality service matters and demonstrates an ability to perform more complex processes related to insurance verification, authorization, and financial clearance. This position will also utilize effective communication skills in all interactions with patients, co-workers, insurance companies, physicians etc.
PATIENT AGE GROUP(S) AND POPULATION(S) SERVED
Refer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.
HOUSTON METHODIST EXPERIENCE EXPECTATIONS
Provide personalized care and service by consistently demonstrating our I CARE values:
INTEGRITY: We are honest and ethical in all we say and do.
COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
ACCOUNTABILITY: We hold ourselves accountable for all our actions.
RESPECT: We treat every individual as a person of worth, dignity, and value.
EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.
Focuses on patient/customer safety
Delivers personalized service using HM Service Standards
Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)
Intentionally rounds with patients/customers to ensure their needs are being met
Involves patients (customers) in shift/handoff reports byenabling their participation in their plan of care as applicable to the given job
Displays cultural humility, diversity, equity and inclusion principles
Actively supports the organization vision, fulfills the mission and abides by the I CARE values
PRIMARY JOB RESPONSIBILITIES
Job responsibilities labeled EF capture those duties that are essential functions of the job.
PEOPLE - 15%
Promotes a positive work environment and contributes to a dynamic, team focused work unit that actively helps one another achieve optimal department results. (EF)
Supports Insurance Verifiers with questions regarding pending authorizations and eligibility/benefit information for patients receiving services. Assists other team members (e.g., registration, financial counseling) as directed by management. Seeks management assistance appropriately. (EF)
Contributes to patient, employee, and physician satisfaction. Proactively presents solutions to resolve access to care issues when possible. Serves as a liaison between the patients, facility, physicians, and department to ensure timely and accurate financial clearance of all accounts. Communicates with scheduling to inform patient of authorization as needed. (EF)
Trains and mentors new team members. (EF)
SERVICE - 25%
Ensures accounts are financially secure by reviewing and documenting benefits, patient liabilities, authorization/pre-certification requirements, notification requirements, and other relevant information. Assists with resolving electronic health record (EHR) work queues that support insurance verification. Generates reports and assists with department correspondence as directed. (EF)
Initiates authorization for services as needed utilizing clinical information provided by the ordering physician. Monitors and tracks authorizations, including ensuring accurate Current Procedural Terminology (CPT) codes, location of service performed and expiration dates. (EF)
Communicates to resolve complex patient access and quality service matters. Responds promptly to requests and keeps open channels of communication with physician, patient, and service areas regarding financial clearance status and resolution. Communicates openly in a non-judgmental and professional demeanor during all interactions with customers and co-workers. Maintains confidentiality in all communications. (EF)
QUALITY/SAFETY - 20%
Timely and accurately obtains and records eligibility and benefit information, including limitations and exclusions, for all patients in the appropriate system(s) and screen(s)/field(s) within the system(s).
Refers to the Health Care System’s financial clearance policy as a guideline and documents the appropriate patient liability portion – co-pays and/or deductibles – prior to, or on, the day of service. (EF)
Provides expert level analysis of accounts and completes high-quality work while adhering to productivity standards. (EF)
FINANCE - 25%
Utilizes multiple online resources to initiate and verify authorization needed for prompt submission. Notifies the payer of the patient’s admission or procedure in a timely manner, to ensure third party reimbursement. (EF)
Evaluates patient liability and generates estimates as needed for patient financial responsibility communication. (EF)
Organizes time effectively, minimizing incidental overtime, and sets priorities. Utilizes time between heavy workloads efficiently and helps other team members. (EF)
GROWTH/INNOVATION - 15%
Displays initiative to improve job functions. Generates and communicates new ideas and suggestions that will improve quality or service. Offers suggestions to streamline process for efficient patient flow. (EF)
Participates in various department and/or entity/system-wide projects and activities. Demonstrates adaptability and flexibility during changing demands. Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development. (EF)
This job description is not intended to be all inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.
o High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
o Three years of insurance verification experience in a healthcare setting, preferably in a hospital or clinic setting
CERTIFICATIONS, LICENSES AND REGISTRATIONS REQUIRED
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
o Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
o Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
o Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
o Proficiency in Microsoft office components (e.g., Outlook, Word) and knowledge of electronic health record software (EPIC preferred)
o Knowledge of Medicare, Medicaid, and managed care reimbursement methodologies
o Ability to manage multiple tasks at one time
o Understands medical terminology at a high level and has knowledge of insurance requirements for physician visits and procedures
o Ability to manage a fast-paced environment
o Ability to flex hours and work/day assignments to meet needs related to unanticipated patient volume
o Ability to review clinical documentation for Medical Necessity and payer requirements
o Working knowledge of CPT, International Classification of Diseases (ICD)-9 and/or ICD-10 preferred
Work Attire Yes/No
Business professional Yes
Other (dept approved) No
*Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Event, etc) regardless of selection above.
May require travel within Yes
Houston Metropolitan area
May require travel outside No
of Houston Metropolitan area
**Travel specifications may vary by department.
Please note any other special considerations to this job: ________
Since its founding in 1919, Houston Methodist Hospital has earned worldwide recognition. Houston Methodist Hospital is affiliated with the Weill Medical College of Cornell University and New York-Presbyterian Hospital, one of the nation's leading centers for medical education and research. In 2020, U.S. News & World Report named Houston Methodist Hospital to its top ranked Honor Roll for the fourth time and second consecutive year. 2020 also marked the ninth year in a row Houston Methodist Hospital has been named the No. 1 hospital in Texas. Houston Methodist Hospital directs millions of research dollars into patient care and offers the latest innovations in medical, surgical and diagnostic techniques. With 952 operating beds, 85 operating rooms and over 8,000 employees, Houston Methodist offers complete care for patients from around the world.
The same high-quality care for which Houston Methodist is known is available at several Emergency Care Centers in Houston and the surrounding areas. These Emergency Care Centers house exam rooms, full digital radiography suite, low radiation dose 16-slice CT scan, ultrasound and a full on-site stat chemistry lab.
Street: 7550 Greenbriar Drive
Name: Pat Acc Serv-Ins Verification
Regular Shift: 1st - Day