Job Description.
Insurance Verifier. Work Synopsis At Houston Methodist, the Protection Verifier is answerable for getting and recording qualification and advantage data for patients getting administrations, checking approval, and finishing hospitalization sees as relevant to the department.
Other duties include calculating patient co-pays and preparing estimates as needed to determine patient financial responsibility. This position also utilizes effective communication skills in all interactions with patients, co-workers, insurance companies, and physicians.
REQUIREMENTS
PRIMARY JOB RESPONSIBILITIES
Job responsibilities labeled EF represent duties that are an essential function of the position
PEOPLE – 10% – Promote a positive work environment and contribute to a dynamic, team-oriented workplace. (Contributes to patient, employee and physician satisfaction. Whenever possible, proactively present solutions to access to care issues.
Serve as a liaison between patients, facilities, physicians, and departments to ensure that all accounts are processed in a timely and accurate manner. Scheduling and communicating and communicating authorizations to patients as needed. Insurance Verifier
(Ensure accounts are financially secure by reviewing and documenting benefits, patient liabilities, authorization/preauthorization requirements, notification requirements, and other relevant information. (EF)
Monitor and track authorizations, including verifying accurate Current Procedural Terminology (CPT) codes, location of services performed, and expiration dates. (EF)
Communicate to resolve issues related to patient access and quality services. Respond promptly to requests and maintain open communication channels with physicians, patients, and service departments regarding financial clearance status and resolution. Maintain confidentiality in all communications. (EF)
QUALITY/SAFETY – 30% – Capture and record all patient eligibility and benefit information, including limitations and exclusions, on appropriate systems and screens/fields within systems in a timely and accurate manner. (EF) – Allude to the medical care framework’s Monetary Leeway Strategy as a rule and report the suitable patient offer (co-installments as well as deductibles) before or on the date of administration.(EF) – Complete quality work in compliance with productivity standards. Ensure documentation standards are followed and accounts are timely and accurately recorded in the appropriate system. (EF)
Financial – 25% – Notify payers of patient admissions or procedures in a timely manner to ensure third party reimbursement. (EF) – Evaluate patient’s liability for payment and prepare estimates as needed for communication regarding patient’s liability for payment. (EF) – Organize time effectively, minimize incidental overtime, and set priorities. Effectively utilize time between heavy workloads to assist other team members. (EF)
Growth/Innovation – 10% – Demonstrate initiative and improve job duties. Shows versatility and adaptability notwithstanding evolving requests. Provide suggestions to streamline processes for efficient patient flow. (EF) – Participates in a variety of projects and activities throughout the department and/or organization/system. Seeks opportunities to expand learning beyond basic competencies with an emphasis on continuous development. (EF)
This set of working responsibilities isn’t planned to be comprehensive and the worker will likewise perform other sensibly related obligations/obligations as appointed. Houston Methodist claims all authority to update obligations and obligations on a case by case basis.
QUALIFICATIONS REQUIREMENTS – High school diploma or equivalent education (e.g., GED, homeschool equivalency certification, completion of partial or full post-secondary education, etc.)
e.g. GED, homeschool equivalency certification, completion of partial or full post-secondary education, etc.)
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Required Knowledge, Skills, and Abilities ( Insurance Verifier )
– Demonstrated skills and abilities necessary to safely perform assigned duties through ongoing skills, competency assessments, and performance evaluations – Conversational English required to perform the essential functions of this position, particularly with respect to activities affecting the safety and security of patients and employees, Demonstrated ability to read and write well – Demonstrated ability to communicate effectively with patients, physicians, family members, and co-workers.
Demonstrate the skills and competencies necessary to safely perform assigned duties through ongoing skills, competence assessments, and performance evaluations. Insurance Verifier
Qualifications.
-High School Diploma or equivalent (Bachelor’s degree)
High school diploma or equivalent (e.g., GED: High school diploma or equivalent (e.g., GED, proof of equivalent education at home, partial or full completion of post-secondary education, etc.)-GED.
One year of medical experience, preferably in a hospital or clinic, including insurance verification.
-Preferably in a hospital or clinic.
Required certifications, licenses, and registrations.
None.
-English
Demonstrate sufficient proficiency in speaking, reading, and writing English to perform the essential functions of this position, particularly with respect to activities affecting the safety and security of patients and employees. Insurance Verifier
- -Demonstrates a
- Ability to communicate effectively with patients, physicians, family members, and co-workers in a customer service oriented manner, applying positive language principles.
- -Medicaid.
- Information on Federal medical care, Medicaid, and oversaw care repayment techniques.
- Capacity to deal with different errands all at once.
- -Medical terminology at an intermediate level
- Knowledge of intermediate level medical terminology and insurance requirements for physician visits and procedures
Ability to manage a fast-paced environment.
Flexibility to change work hours and days to accommodate unanticipated increases in patient volume.
- Responsibilities.
- Other duties as assigned.
- Other duties may include patient liability calculations and estimate preparation as needed to determine patient financial responsibility.
- Other duties as assigned.
- This position will likewise use successful relational abilities in all associations with patients, collaborators, insurance agency, doctors, and so forth.
- This position will be responsible for the following.
- The job responsibilities listed on the EF label are essential functions of the position.
- Promotes a positive work environment.
- Promote a positive work environment and contribute to a dynamic, team-oriented workplace.
- Speak with patients, representatives, and doctors to guarantee
- Contribute to patient, employee and physician satisfaction.
- -Contribute to patient, employee, and physician satisfaction.
- Where possible, proactively present solutions to access to care issues.
- -Contribute to the satisfaction of patients, employees, and physicians
- Serve as a liaison between patients, facilities, physicians, and departments to ensure that all accounts are processed in a timely and accurate manner.
- -Serves as a liaison between patients, facilities, physicians, and departments.
- Scheduling and communicating with and notifying patients of authorizations as needed.
- -Serves as a liaison between the patient facility, physicians, and departments to ensure that all
- Guarantee accounts are monetarily secure by surveying and reporting benefits, patient liabilities, approval/preauthorization prerequisites, notice necessities, and other pertinent data.
- -Ensure that the account is financially secure.
- Monitor and track authorizations, including verifying accurate CPT (Current Procedural Terminology) codes, location of services performed, and expiration dates.
- -Monitors and tracks
- Communicate to resolve issues related to patient access and quality services.
- -Communication to resolve patient access and quality service issues
- Communicate to resolve issues related to patient access and quality services.
- -Communication to resolve issues related to patient access and quality services.
- Maintain confidentiality in all communications.
- -Communicate to resolve patient access and quality service issues -Adhere to confidentiality in all communications
- Capture and record all patient eligibility and benefit information, including limitations and exclusions, in appropriate systems and screens/fields within systems in a timely and accurate manner.
- -Undertake all necessary steps to ensure that the health care system’s
- Refer to the health care system’s Financial Clearance Policy as a guideline and document appropriate patient contributions (co-payments and/or deductibles) prior to or on the date of service.
- -Caregivers.
- Performs quality work while adhering to productivity standards.
- -Documentation.
- Ensure documentation standards are followed and accounts are timely and accurately recorded in the appropriate system.
- -Ensures that the
- Notify payers in a timely manner of patient admissions or procedures to ensure reimbursement from third parties.
- -Maintains and manages the patient’s medical records in a timely manner.
- Effectively manage time, minimize incidental overtime, and set priorities.
- –
- Effectively utilize time between heavy workloads to assist other team members.
- Take initiative to improve job duties.
- -Adapt to changing demands.
- Demonstrate adaptability and flexibility when demands change.
- -Exercise flexibility and adaptability to changing demands.
- Provide suggestions to streamline processes for efficient patient flow.
- -Makes recommendations to improve the efficiency of the process for efficient patient flow.
- Participates in various departmental and/or organization/system-wide projects and activities.
- -Participate in various departmental and/or organizational/system-wide projects and activities.
- This expected set of responsibilities isn’t planned to be comprehensive. The employee will also perform other reasonably related duties/tasks as assigned.
Houston Methodist
Houston Methodist claims all authority to reexamine obligations and obligations on a case by case basis.
Must be customer service oriented, apply principles of positive language, be proficient in Microsoft Office components (e.g., Outlook, Word) and knowledgeable in electronic health record software (EPIC
preferred) – Knowledge of Medicare, Medicaid and managed care reimbursement methods Ability to manage multiple tasks at one time
– Knowledge of intermediate level medical terminology and insurance requirements for physician visits and procedures
– Ability to manage a fast-paced environment
– Ability to be flexible in assigning work hours and days to accommodate needs related to unanticipated patient volume Ability to modify work hours and work day assignments to meet needs related to unanticipated patient volumes
– Working knowledge of CPT, International Classification of Diseases (ICD)-9 and/or ICD-10 preferred
Supplemental Requirements
Clothing Yes/No
Uniform No
Scrubs Business Professional Yes
Other (department approved) No
On-Call* No – Emergency (disasters, inclement weather, etc.) may be required to be on-call. Note that in the event of an emergency (e.g., disaster, inclement weather, etc.), on-call may be required regardless of the above selection. Insurance Verifier
Travel
Travel within the Houston metropolitan area may be required
Travel outside of the Houston metropolitan area may be required
Travel assignments may vary by department.
Please indicate any other special considerations for this position!
Company Description
Houston Methodist Woodlands Hospital is committed to leading healthcare in Montgomery County and the north Houston area by providing Houston Methodist’s standards of excellence in safety, quality, service, and innovation. Insurance Verifier
The hospital has 293 beds and is a growing campus offering the most innovative medical care available.In January 2022, the hospital opened the Healing Tower, a $250 million expansion project. The project added 106 beds, primarily in medicine and surgery and women’s services, and nine operating rooms. Insurance Verifier
It likewise included development of the endoscopy place, crisis division, and analytic imaging office.Houston Methodist Woodlands has been recognized as a Comprehensive Stroke Center, an Orthopedic Center of Excellence by DNV, a Level III Neonatal Intensive Care Unit, and has earned Magnet Designation for Nursing Excellence by the ANCC. Insurance Verifier
In addition, Houston Methodist Woodlands was ranked as an outstanding hospital for quality care based on the 2022 Vizient Quality and Accountability Ranking, out of 148 facilities in the Complex Care Medical Centers cohort, the nation’s Houston Methodist Woodlands is ranked #1 in the nation out of 148 hospitals in the Complex Care Medical Centers cohort.Insurance Verifier
Houston Methodist
Conroe, Texas, USA