Senior Insurance Verifier

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.

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.

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 setting

LICENSES AND CERTIFICATIONS - REQUIRED

• N/A

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 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

• Understands medical terminology at a high level and has 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

• Ability to review clinical documentation for Medical Necessity and payer requirements

• 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

Company Profile:

Houston Methodist The Woodlands Hospital opened in June 2017 as the eighth hospital in the Houston Methodist system. This 267-bed, 725,000-square-foot, full-service, acute-care hospital offers many of the same services as our flagship hospital in the Texas Medical Center. Also, on the beautiful hospital campus, located at the intersection of Interstate 45 and Texas State Highway 242, are two medical office buildings, which include a Breast Care Center; Cancer Center; infusion center; heart and vascular services; neurology; orthopedics and sports medicine; rehabilitation services; wellness services; an outpatient laboratory; and several other multispecialty physician practices. In January 2022, Houston Methodist The Woodlands opened Healing Tower — a $250 million expansion project that added 106 beds, focused on medical-surgical and women’s services, and provided nine operating rooms. The project also included the expansion of the endoscopy center, emergency department and diagnostic imaging department with an enhanced neurodiagnostic and interventional center.

Houston Methodist is an equal opportunity employer inclusive of women, minorities, disabled persons and veterans.

Equal Employment Opportunity

Houston Methodist is an Equal Opportunity Employer.

Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor – priority referral Protected Veterans requested.

Houston Methodist is an Equal Opportunity Employer.

Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor – priority referral Protected Veterans requested.