Insurance Verifier I
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POST DATE 9/17/2016
END DATE 10/28/2016
JOB DESCRIPTIONJob Summary
The Insurance Verifier I is responsible for obtaining and recording eligibility and benefit information for patients receiving services at Houston Methodist. The incumbent will utilize on-line resources such as PWL and payers websites, as well as the phone, to obtain the necessary information to provide financial clearance and to successfully secure accounts for elective and urgent services timely. The Insurance Verifier will utilize effective communication skills in all interactions with patients, co-workers, insurance companies, physicians, etc. Knowledge of Medicare, Medicaid, and managed care reimbursement methodologies, as well as utilization requirements, will assist in ensuring that criteria for coverage and reimbursement are met. The incumbent will initiate the admission notification/pre-certification/authorization process in a timely manner. Competency requirements for computer entry, as well as insurance procedures, will be maintained.
PATIENT AGE GROUP SERVED
Neonate to Mature Adult
System and department specific ICARE 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.
1. Alerts management about difficult situations with insurance companies.
2. Contributes to departmental and hospital patient satisfaction.
3. Communicates openly in a non-judgmental and professional demeanor during all interactions with customers and co-workers.
1. Makes physicians and other pertinent parties aware of situation(s) affecting the financial clearance of their patient(s).
2. Serves as the resource person for billing and insurance questions.
1. Completes account work timely and accurately using the appropriate workdriver.
2. Ensures documentation standards are followed and account notations are made in the appropriate system(s) timely and accurately.
3. Completes high-quality work while adhering to productivity standards.
4. Demonstrates excellent skills in obtaining and recording eligibility and benefit information for all patients in the appropriate system(s) and screen(s)/field(s) within the system(s).
5. Reviews the managed care contract database/matrices for information related to the contract terms and the corresponding estimated patient portion.
6. 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.
7. Follows all safety rules while on the job.
8. Reports accidents promptly and corrects minor safety hazards
1. Ensures accounts are financially secure by reviewing and documenting benefits, patient liabilities, authorization/pre-certification requirements, notification requirements, and other relevant information.
2. Notifies the payer of the patient s admission or procedure in a timely manner, to ensure third party reimbursement.
1. Participates in departmental and hospital performance improvement plans.
2. Supports Pre-registration team needs when insurance verification requirements are completed and/or as indicated by workdriver
3. Supports other insurance verification department needs in other HM hospitals as indicated by workdriver
This position description is not intended to be all inclusive, and the employee will also perform other reasonably related business duties as assigned by the immediate supervisor and other management as required. The Houston Methodist Hospital reserves the right to revise or change job duties and responsibilities as the need arises.
High School graduate or GED
College hours preferred
Minimum of 1 year in hospital patient registration experience which must have included insurance verification in a healthcare setting preferably in a hospital
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
HIS experience preferred
Microsoft Outlook preferred
Computer skills required
Ability to manage multiple tasks at one time
Ability to manage a fast-paced environment
Ability to manage multiple phone calls at one time
Strong interpersonal skills, with ability to work effectively with a variety of health professionals.
Proficient in English, written and verbal; excellent communication skills
Knowledge of Medicare, Medicaid and managed care reimbursement methodologies
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.