Senior Insurance Authorization Specialist - (Telecommute - Must Reside in TX)

Overview

At Houston Methodist, the Senior Insurance Authorization Specialist position is responsible for obtaining and managing insurance authorizations for medical services, complex procedures and treatments, and complex insurance plans (i.e. CVCP, Transplant). Other duties may include obtaining insurance verification. This position will utilize effective communication skills in all interactions with patient's, co-workers, insurance companies, physicians, and other clinical and administrative partners.

Houston Methodist Standard

PATIENT AGE GROUP(S) AND POPULATION(S) SERVEDRefer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.

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 organization's vision, fulfills the mission and abides by the I CARE values

Responsibilities

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.

• Serves as a liaison between the patient's, facilities, physician's, 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.

SERVICE ESSENTIAL FUNCTIONS

• 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 physician's, patient's and operational partners regarding authorization status and resolution.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• 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.

FINANCE ESSENTIAL FUNCTIONS

• Utilizes multiple online resources to initiate and verify proper insurance authorization is obtained timely and accurately prior to the patient's 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.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Displays initiative to improve job functions. Demonstrates adaptability and flexibility during changing demands.

• Offers suggestions to streamline processes for efficient patient flow.

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 responsibili