Houston Methodist
Sr Insurance Verifier
Houston Methodist, Cypress, Texas, us, 77410
Overview
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.
Houston Methodist Standard
PATIENT AGE GROUP(S) AND POPULATION(S) SERVEDRefer 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 EXPECTATIONSProvide 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.
Practices the Caring and Serving ModelDelivers personalized service using HM Service StandardsProvides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience.Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given jobDisplays cultural humility, diversity, equity and inclusion principlesActively supports the organization's vision, fulfills the mission and abides by the I CARE valuesResponsibilities
PEOPLE ESSENTIAL FUNCTIONS
Promotes a positive work environment and contributes to a dynamic, team focused work unit that actively helps one another achieve optimal department results.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.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.Trains and mentors new team members.SERVICE ESSENTIAL FUNCTIONS
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.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.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.QUALITY/SAFETY ESSENTIAL FUNCTIONS
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.Provides expert level analysis of accounts and completes high-quality work while adhering to productivity standards.FINANCE ESSENTIAL FUNCTIONS
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.Evaluates patient liability and generates estimates as needed for patient financial responsibility communication.Organizes time effectively, minimizing incidental overtime, and sets priorities. Utilizes time between heavy workloads efficiently and helps other team members.GROWTH/INNOVATION ESSENTIAL FUNCTIONS
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.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.
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.
Qualifications
EDUCATION
High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)WORK EXPERIENCE
Three years of insurance verification experience in a healthcare setting, preferably in a hospital or clinic settingLicense/Certification
LICENSES AND CERTIFICATIONS - REQUIRED
N/AKSA/ Supplemental Data
KNOWLEDGE, SKILLS, AND ABILITIES
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluationsSufficient 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 securityAbility 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 principlesProficiency in Microsoft office components (e.g., Outlook, Word) and knowledge of electronic health record software (EPIC preferred)Knowledge of Medicare, Medicaid, and managed care reimbursement methodologiesAbility to manage multiple tasks at one timeUnderstands medical terminology at a high level and has knowledge of insurance requirements for physician visits and proceduresAbility to manage a fast-paced environmentAbility to flex hours and work/day assignments to meet needs related to unanticipated patient volumeAbility to review clinical documentation for Medical Necessity and payer requirementsWorking knowledge of CPT, International Classification of Diseases (ICD)-9 and/or ICD-10 preferredSUPPLEMENTAL REQUIREMENTS
WORK ATTIRE
Uniform NoScrubs NoBusiness professional YesOther (department approved) NoON-CALL**Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.
On Call* NoTRAVEL****Travel specifications may vary by department**
May require travel within the Houston Metropolitan area YesMay require travel outside Houston Metropolitan area No
Company Profile
Houston Methodist Cypress Hospital, scheduled to open in the first quarter of 2025, will be Houston Methodist's ninth hospital and will incorporate the most advanced technology available from the day the doors open. With 100 beds (at our opening; licensed for 276) and a prime location in the heart of the rapidly growing U.S. 290 corridor, the hospital will be equipped with technologically advanced innovations implemented during COVID, many of them designed to make patient communication with physicians, staff and families the very best and most effective in any health care facility. Even though the hospital won't be fully operational until 2025, we have several services and specialties opening in 2024.
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.
Houston Methodist Standard
PATIENT AGE GROUP(S) AND POPULATION(S) SERVEDRefer 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 EXPECTATIONSProvide 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.
Practices the Caring and Serving ModelDelivers personalized service using HM Service StandardsProvides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience.Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given jobDisplays cultural humility, diversity, equity and inclusion principlesActively supports the organization's vision, fulfills the mission and abides by the I CARE valuesResponsibilities
PEOPLE ESSENTIAL FUNCTIONS
Promotes a positive work environment and contributes to a dynamic, team focused work unit that actively helps one another achieve optimal department results.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.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.Trains and mentors new team members.SERVICE ESSENTIAL FUNCTIONS
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.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.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.QUALITY/SAFETY ESSENTIAL FUNCTIONS
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.Provides expert level analysis of accounts and completes high-quality work while adhering to productivity standards.FINANCE ESSENTIAL FUNCTIONS
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.Evaluates patient liability and generates estimates as needed for patient financial responsibility communication.Organizes time effectively, minimizing incidental overtime, and sets priorities. Utilizes time between heavy workloads efficiently and helps other team members.GROWTH/INNOVATION ESSENTIAL FUNCTIONS
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.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.
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.
Qualifications
EDUCATION
High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)WORK EXPERIENCE
Three years of insurance verification experience in a healthcare setting, preferably in a hospital or clinic settingLicense/Certification
LICENSES AND CERTIFICATIONS - REQUIRED
N/AKSA/ Supplemental Data
KNOWLEDGE, SKILLS, AND ABILITIES
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluationsSufficient 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 securityAbility 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 principlesProficiency in Microsoft office components (e.g., Outlook, Word) and knowledge of electronic health record software (EPIC preferred)Knowledge of Medicare, Medicaid, and managed care reimbursement methodologiesAbility to manage multiple tasks at one timeUnderstands medical terminology at a high level and has knowledge of insurance requirements for physician visits and proceduresAbility to manage a fast-paced environmentAbility to flex hours and work/day assignments to meet needs related to unanticipated patient volumeAbility to review clinical documentation for Medical Necessity and payer requirementsWorking knowledge of CPT, International Classification of Diseases (ICD)-9 and/or ICD-10 preferredSUPPLEMENTAL REQUIREMENTS
WORK ATTIRE
Uniform NoScrubs NoBusiness professional YesOther (department approved) NoON-CALL**Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.
On Call* NoTRAVEL****Travel specifications may vary by department**
May require travel within the Houston Metropolitan area YesMay require travel outside Houston Metropolitan area No
Company Profile
Houston Methodist Cypress Hospital, scheduled to open in the first quarter of 2025, will be Houston Methodist's ninth hospital and will incorporate the most advanced technology available from the day the doors open. With 100 beds (at our opening; licensed for 276) and a prime location in the heart of the rapidly growing U.S. 290 corridor, the hospital will be equipped with technologically advanced innovations implemented during COVID, many of them designed to make patient communication with physicians, staff and families the very best and most effective in any health care facility. Even though the hospital won't be fully operational until 2025, we have several services and specialties opening in 2024.