Insurance Verifier

At Houston Methodist, the Insurance Verifier position is responsible for obtaining and recording eligibility and benefit information for patients receiving services, confirming authorizations, and completing admission notifications as applicable to department. Other duties may include calculating patient liability and generating estimates as needed to determine patient financial responsibility. This position will also utilize effective communication skills in all interactions with patients, co-workers, insurance companies, physicians etc.

FLSA STATUS
Non-exempt

QUALIFICATIONS

EDUCATION

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

EXPERIENCE

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

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
• 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

ESSENTIAL FUNCTIONS

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.
• 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.

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.
• 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.

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.
• 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.

FINANCE ESSENTIAL FUNCTIONS

• 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. 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.

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

QUALIFICATIONS

EDUCATION

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

EXPERIENCE

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