Sr Insurance Verifier – PT/Days

Houston, Texas
Houston Methodist Hospital

JOB SUMMARY

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.

PRIMARY JOB RESPONSIBILITIES

Job responsibilities labeled EF capture those duties that are essential functions of the job.

PEOPLE – 15%

1. Promotes a positive work environment and contributes to a dynamic, team focused work unit that actively helps one another achieve optimal department results. (EF)
2. 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)
3. 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)
4. Trains and mentors new team members. (EF)

SERVICE – 25%

1. 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)
2. 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)
3. 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%

1. 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).
2. 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)
3. Provides expert level analysis of accounts and completes high-quality work while adhering to productivity standards. (EF)

FINANCE – 25%

1. 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)
2. Evaluates patient liability and generates estimates as needed for patient financial responsibility communication. (EF)
3. Organizes time effectively, minimizing incidental overtime, and sets priorities. Utilizes time between heavy workloads efficiently and helps other team members. (EF)

GROWTH/INNOVATION – 15%

1. 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)
2. 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.

EDUCATION REQUIREMENTS

o High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)

EXPERIENCE REQUIREMENTS

o Three years of insurance verification experience in a healthcare setting, preferably in a hospital or clinic setting

CERTIFICATIONS, LICENSES AND REGISTRATIONS REQUIRED

o None

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

SUPPLEMENTAL REQUIREMENTS

Work Attire Yes/No

Uniform No

Scrubs No

Business professional Yes

Other (dept approved) No

On-Call No

Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Event, etc) regardless of selection above.

Travel

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:

Company Profile:

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 2022, U.S. News & World Report named Houston Methodist Hospital to its prestigious Honor Roll for the sixth time. Also, in this year’s rankings, Houston Methodist Hospital was named the No. 1 hospital in Texas for the 11th year in a row. Houston Methodist Hospital directs millions of research dollars into patient care and offers the latest innovations in medical, surgical and diagnostic techniques. With 946 operating beds, 85 operating rooms and nearly 8,500 employees, Houston Methodist Hospital offers complete care for patients from around the world.