Job Ref: 27301
Talent Area: Administrative Management
Houston Methodist Specialty Physician Group
Houston, TX 77030
Area/Department: Cardiology Billing
Employment Type: Regular
Job Type: Full-Time
Organization: Houston Methodist
Work Shift: DAY
Work Week: M - F
Since its founding in 1919, Houston Methodist Hospital has earned worldwide recognition. Houston Methodist Hospital is affiliated with the Weill Medical College of Cornell University and New York-Presbyterian Hospital, one of the nation's leading centers for medical education and research. Houston Methodist is consistently ranked in U.S. News & World Report’s “Best Hospital” list and was recently named the number one hospital in Texas. FORTUNE magazine has placed Houston Methodist on its annual list of “100 Best Companies To Work For” since 2006. Houston Methodist Hospital directs millions of research dollars into patient care and offers the latest innovations in medical, surgical and diagnostic techniques. With 1,119 licensed beds, 67 operating rooms and over 6,000 employees, Houston Methodist offers complete care for patients from around the world.
The Patient Access Center - Patient Access Coordinator trains new patient access team members throughout the organization on Patient Access processes and systems. Develops and maintains training materials and reference documents. Performs quality assurance audits on Patient Access team members for adherence to policies and procedures.
PATIENT AGE GROUP SERVED
Select the applicable age group(s) of primary customers/patients served by this position.
Neonate (Birth to 28 days)
Infants/Toddlers (29 days to 18 months)
Toddler (18 months to 3 years)
Preschooler (3-6 years)
School Age (6-12 years)
Adolescence (12-18 years)
Young Adult (19-40 Years)
Middle Adult (40-65 Years)
Mature Adult (65 years and older)
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. This employee will use independent judgment and clinical knowledge to adjust clinic and physicians schedules and accommodate special requests from internal and external customers as indicated.
2. This employee will work with the physician templates and clinical protocols directly as indicated by management and physicians on an as needed basis
3. The employee will have interactions with all levels of staff and management, physicians, patients and families to obtain information and properly schedule and register services.
4. The employee will be responsible for the Patient Access Center directly and triage calls as appropriate to other areas as received on a daily basis while working under the guidelines and scripts as set forth by management
5. Provide patients with information needed to prepare for appointment per Center/Service protocol. Enroll patients on the Patient Portal if indicated and provide PIN numbers, complying with HIPAA regulations.
6. Keeps open channels of communication with all parties involved: physician, patient, service areas, regarding action taken and resolution.
7. Assist ProviderMatch users with login issues and help escalate to Kyruus support when necessary.
8. Assist Department Leadership with ProviderMatch Clinical Scope of Practice Configurations.
9. Coordinate with Department Leadership training schedule for all new users.
10. Work with Department Leadership to identify and setup user profiles for ProviderMatch reporting.
1. Utilizes courteous and professional telephone techniques and interpersonal skills to establish and maintain rapport with patients, physicians/office personnel and various hospital personnel, while maintaining patient confidentiality. Appropriately utilizes ACD/CISCO telephone system.
2. Use Department Scripting and Appointment scheduling policy when scheduling appointments and ensures ICARE values are met while working within the scripting provided.
3. Communicates appropriately via email to the assistants/PA¿s with the patients request for appointment when schedule is booked and works directly with the clinical team for scheduling conflicts, special requests, and urgent patient needs as directed via the physician protocol.
4. Assist with new referrals from E-fax, Emails along with specific doctor¿s offices calling directly to schedule emergency patients same day or within 24 hours
5. Provides coverage for operator during transitions and as needed per management discretion.
6. Review ProviderMatch feedback submissions and help resolve the issue(s) with Kyruus Support and Department Management.
7. Responsible for managing the flow of patient referrals:
A. Collecting and compiling data/information from patients such as insurance documentation and patient identification information to help facilitate an appointment with a SPG/PCG provider.
B. Screen and assess patient calls received and assure that the patients are scheduled for services as requested by referring physician.
C. Schedule patient appointments.
D. Verify patient benefits for eligibility.
E. Efficiently complete registration.
F. Pre-certify with insurance companies if necessary.
G. Answer incoming calls from patients regarding the status of their referrals progress.
H. Act as liaison between the patient and the physician.
I. Handle calls from physician`s offices, always making sure to maintain a good relationship.
J. Obtain all necessary documents needed to support the referral process.
K. Close out referral process.
8. Help facilitate and coordinate and resolve referral issues with patients by exhibiting and exercising exceptional telephone, verbal, written, exemplary critical thinking and interpersonal communication skills.
9. Provided empathetic patient care by focusing on maintaining friendly, and incredibly dynamic environment
10. ProviderMatch User Assistance
a. Existing users:
a. Assist ProviderMatch users with login issues and help escalate to Kyruus support when necessary.
b. New User Access:
a. Help identify department champions ¿super users¿ within each practice and request user access.
c. Request, monitor, track and report user access status.
a. Work with Kyruus to obtain, maintain and update user list.
b. Work with Kyruus on urgent user requests.
d. Department ¿Super User¿/ User Training and Support
a. address questions about using ProviderMatch within their practice workflows
b. train on how to escalate questions/recurring issues with ProviderMatch.
c. Provide additional training and support to super users as needed.
d. Provide super user training on Kyruus and Athena reporting and workflows.
e. Training all new users on Kyruus ProviderMatch:
a. Host weekly training sessions for all new PCG/SPC physicians and staff.
11. ProviderMatch Technical Issues
a. Review ProviderMatch feedback submissions and help resolve the issue(s) with Kyruus Support and Department Management.
i. Review, route and prioritize ¿ProviderMatch Help¿ submissions and triage accordingly.
b. Work with the HM Administrative team, physicians and Kyruus on adding and deleting physician profile clinical terms.
c. Work with the Administrator to confirm how to add new clinical terms (include, exclude, boost).
d. Update all Kyruus Scope of Practice (SOP) configuration for new terms in Kyruus PMA.
12. ProviderMatch Clinical Scope of Practice Configurations
a. Work with Kyruus to configuration Specialist SOP profiles for new providers during the on-boarding process.
b. Work with the Department Administrator to identify the specialties/sub-specialties to be added to the new provider¿s profile.
c. Work with the Department Administrator to validate the standard set of corresponding clinical SOP terms for all Specialists.
d. Work with the Department Administrator to review and validate the case types seen and configure in PMA as appropriate.
13. Work with Department leadership to identify new physician and non-physician users.
a. Request new user access.
14. Coordinate with Athena/Epic Team Go-Live Events.
1. This position will work directly revenue cycle team and other departments to ensure the correct information and registration is complete and accurate prior to the patient visiting the clinic. This position will identify areas of concern and improvement to better the team and the overall practice in collecting revenue from front end operations being faulty.
2. Documents patient¿s accounts with information related to any potential issue(s) that could result in service delays or cancellations due to the lack of financial clearance.
3. Insurance Updates to ProviderMatch
a. Work with the Managed Care Office on a monthly basis to update ProviderMatch insurance profiles.
b. Work with Managed Care office to submit updated insurance files to Kyruus Support Team using the approved format, timeline and monthly process.
1. Utilize resources to perform verification of patient insurances. Obtains required data in order to support departmental and hospital clinical/financial needs.
2. Maintain standard of productivity set by department policy and procedures
3. Uses established auditing procedures to process appointments and registrations.
4. Provide patients with information needed to prepare for appointment per Center/Service protocol. Enroll patients on the Patient Portal and provide PIN numbers, complying with HIPAA regulations.
5. Follows all safety rules while on the job. Reports accidents promptly and corrects minor safety hazards Report to management observed issues and opportunities in processes while including troubleshooting and problem solving.
6. Provide team with ongoing coaching and training needs to include new hire training, one on ones, auditing, shadowing, and communication with clinic office staff for updates.
7. Deleting Providers in ProviderMatch
a. Work with Managed Care Team, Business Development and the Kyruus Team on a monthly basis to update termed providers.
8. ProviderMatch Scope of Practice Review and Reporting
a. Work with the Kyruus team to provide Department Administrator (DA) / designee within practice with clinical line-up reports on a quarterly basis.
b. Work with the DA or designee to review and validate the clinical line-up report for accuracy and consistency with group/department goals
9. ProviderMatch Product Releases
a. Work with Kyruus regarding the coordination of periodically product roll outs.
b. Distribute and communicate new/updated release information to the departments as necessary.
c. Distribute within Houston Methodist; release notes to include:
i. Description of the enhancement
ii. Expected impact to end user
10. ProviderMatch and Athena Reporting
a. Run, Review and Distribute Weekly Patient Access and Kyruus Reporting
11. ProviderMatch Change Request
a. Review and submit change request to Kyruus support:
12. Coordinate with Department leadership training schedule for all new users.
13. Onsite Visits Post Go-Live
a. Maintain visibility onsite through go-live events and usage/adoption phase.
b. Coordinate with Department/practice leadership planned onsite visits to include observation of workflow to ensure adoption and usage of the ProviderMatch tool.
1. Answer calls in a timely manner
2. Assist the manager in developing and implementing departmental policies and procedures.
3. Works with manager to improve areas requiring concern as indicated and strives for excellence in the workplace
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 Diploma or G.E.D.; Associate¿s Degree preferred.
Five or more years of physician practice experience is required. Three years or more of scheduling experience is required. Must have prior training experience.
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
Satisfactory completion and clinical licensure such as MA, LVN program preferred.
SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
Clinical knowledge and experience preferred with a strong understanding of medical terminology.
Excellent communication and interpersonal skills via telephone and in person.
Ability to effectively communicate with management and staff.
Demonstrated proficiency in medical terminology to include diagnoses, operative procedures, and CPT codes.
Excellent spelling/grammar skills. Proficient in reading, writing and speaking the English language.
Capable of working and navigating several applications and Web sites related to registration simultaneously.
Managed care experience with the ability to differentiate between insurance plans such as PPO, POS, HMO, etc.
Must be proficient in Microsoft Word, PowerPoint, Excel, and the internet.
Must be able to type a minimum of 30wpm.
Ability to navigate multiple software programs and multitasks.
Strong sense of integrity.
Basic understanding of adult learning styles.
Highly motivated and capable of managing and prioritizing multiple priorities and meeting established deadlines.
Must be comfortable with public speaking.
Knowledge of Patient Access processes.
Activity Checklist attached (see below). Extended periods of sitting and being on the telephone required. There may be required support at any of our HM satellite office locations.
Normal office conditions.
Travel is required 25-40% of the time to multiple Houston Methodist locations.
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.