Insurance Verifier PT/OT

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.

• Practices the Caring and Serving Model

• 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 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 job

• Actively supports the organizations vision fulfills the mission and abides by the I CARE values

• Promotes a positive work environment and contributes to a dynamic team focused work unit that actively helps one another achieve optimal department results.

• 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.

• Ensures accounts are financially secure by reviewing and documenting benefits patient liabilities authorization/pre-certification requirements notification requirements and other relevant information.

• Monitors and tracks authorizations including ensuring accurate Current Procedural Terminology (CPT) codes location of service performed and expiration dates.

• Communicates to resolve 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. Maintains confidentiality in all communications.

• 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 Systems 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.

• Completes high-quality work while adhering to productivity standards. Ensures documentation standards are followed and account notations are made in the appropriate system(s) timely and accurately.

• Notifies the payer of the patients 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.

• Displays initiative to improve job functions. Demonstrates adaptability and flexibility during changing demands. Offers suggestions to streamline process for efficient patient flow.

• Participates in various department and/or entity/system-wide projects and activities. Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development.

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

• One year of healthcare experience which must have included insurance verification preferably in a hospital or clinic setting

• N/A

• Demonstrates the skills and competencies necessary to safely perform the assigned job determined through on-going skills competency assessments and performance evaluations

• 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

• 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

• Proficiency 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 methodologies

• Ability to manage multiple tasks at one time

• Mid-level medical terminology and knowledge of insurance requirements for physician visits and procedures

• Ability to manage a fast-paced environment

• Ability to flex hours and work/day assignments to meet needs related to unanticipated patient volume

• Working knowledge of CPT International Classification of Diseases (ICD)-9 and/or ICD-10 preferred

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform No
• Scrubs No
• Business professional Yes
• Other (department approved) No

ON-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* No

TRAVEL**
**Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area Yes
• May require travel outside Houston Metropolitan area No

Houston Methodist Clear Lake Hospital brings the expertise and compassionate care of Houston Methodist Hospital in The Texas Medical Center a national Honor Roll hospital to Bay Area communities. The hospital provides a broad spectrum of adult medical and surgical care is an accredited chest pain center and is also acute stroke-ready designated through DNV. Houston Methodist Clear Lake offers many inpatient and outpatient services including 3-D mammography and other state-of-the-art imaging labor and delivery with a level II neonatal ICU Cancer Center of Excellence advanced laparoscopic surgery comprehensive orthopedics and sports medicine neurology urology and otolaryngology. Also Houston Methodist Clear Lake Hospital is honored to be the only hospital in the bay area to have a Grade A rating from Leapfrog Hospital Safety Grading.