Insurance Authorization Specialist- Neurosurgery (Medical Center)

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.

• Serves as a liaison between the patients facilities physicians and department to ensure timely and accurate authorization of all services/visits.

• Collaborate with internal and external stakeholders to overcome challenges in the authorization process.

• Provide clear and timely updates on authorization status to relevant parties as needed.

• Initiate and manage the authorization process for medical services and simple procedures and treatments.

• Maintain accurate and up to date records of all authorization requests and approvals.

• Document communication with insurance providers healthcare professionals and internal stakeholders.

• Collaborate with healthcare providers to gather necessary documentation for insurance authorization requests.

• Responds promptly to requests and keeps open channels of communication with physicians patients and operational partners regarding authorization status and resolution.

• 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.

• Maintains knowledge about insurance regulations policies and procedures to ensure compliance with industry standards.

• Ensures proper insurance authorization is obtained timely and accurately prior to the patients scheduled appointment so there is no disruption to patient care/access and/or insurance payments are not denied.

• 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 processes for efficient patient flow.

• 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 work related to insurance verification insurance authorization or professional accounts receivable activities.

• 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

• Knowledge of Medicare Medicaid and managed care reimbursement methodologies

• Ability to manage multiple tasks in a fast-paced environment

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

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

• Working knowledge of CPT and ICD-10 coding conventions preferred

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

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

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* Yes

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 Specialty Physician Group - As one of the nations leading hospitals and academic medical centers Houston Methodist has brought together some of the nations leading experts in multiple specialties to serve our patients. As part of Houston Methodist Specialty Physician Group (HMSPG) these specialists not only provide excellent clinical care but are on the forefront of research developing leading-edge technologies and treatments and teaching the medical pioneers of tomorrow. This combination of clinical service research and academics ensures patients have access to the latest in treatments and technologies while providing the best in comprehensive patient care. Established as a non-profit corporation and certified by the Texas State Board of Medical Examiners HMSPG enables physicians to maintain autonomy with respect to their clinical practice while growing their practice within an academic environment.