Insurance Verifier - Full Time Days

Overview

Work Schedule:  Monday-Friday, 8a-4:30pm.

 

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.

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.

• 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.