Job Description

Job SummaryJOB 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.

Requirements:

DUTIES AND RESPONSIBILITIES
People 20%
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.

Service 20%
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.

Quality/Safety 20%
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

Finance 20%
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.

Growth/Innovation 20%
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.

Qualifications:

EDUCATION REQUIREMENTS
High School graduate or GED
College hours preferred

EXPERIENCE REQUIREMENTS
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
Not applicable