Insurance Verifier II
Job Ref # 32552
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Location: Houston, TX
Category: Scheduling/Registration

Work Shift: DAY

Work Week: M - F


Job Summary

POSITION SUMMARY
The Insurance Verifier II is responsible for obtaining and recording eligibility and benefit information for patients receiving services at Houston Methodist.  As compared to the Insurance Verifiers, the  Insurance Verifier II focuses on resolving more difficult accounts, resolving escalations from Insurance Verifiers prior to management review, provides expert level analysis of accounts, and serves as a go-to for other Insurance Verifiers for questions, training, and overall assistance in performing daily responsibilities. 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 II will utilize effective communication skills in all interactions with patients, co-workers, insurance companies, physicians, etc. Extensive knowledge of Medicare, Medicaid, and managed care reimbursement methodologies, as well as utilization requirements is required to ensure 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.


PATIENT AGE GROUP SERVED
Neonate to Mature Adult                                                                                                                                                             

ICARE VALUES
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.

JOB RESPONSIBILITIES
Duties and Responsibilities are cross-referenced to the hospital¿s Pillars of Excellence and will be transferred to the Performance Evaluation

People 20%
1. Supports Insurance Verifiers with questions regarding pending authorizations, and eligibility/benefit information for patients receiving services at Houston Methodist.
2. First level of resolution of difficult situations with insurance companies encountered by other members of the team.  Attempts to resolve without management assistance and seeks management assistance appropriately.
3. Contributes to departmental and hospital patient satisfaction.  Assists other team members in resolving patient satisfaction issues and concerns.
4. Communicates openly in a non-judgmental and professional demeanor during all interactions with customers and co-workers.
5. Trains and mentors new Insurance Verifiers on the team.


Service 20%
1. Makes physicians and other pertinent parties aware of situation(s) affecting the financial clearance of their patient(s).  Proactively presents solutions to resolve access to care issues when possible.
2. Serves as the resource person for billing and insurance questions, and resolves patient concerns other insurance verifiers cannot resolve.
3. Performs basic level financial counselor responsibilities, providing coverage for financial counselors when needed.


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. Provides expert level analysis of accounts.
8. Handles complex registration situations.
9. Able to interpret and explain compliance requirements with 3rd party contracts.
10. Follows all safety rules while on the job.
11. 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.
4. Super user of Houston Methodist Workdriver software.


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.


EDUCATION REQUIREMENTS

  1. High School graduate or GED
  2. College hours preferred



EXPERIENCE REQUIREMENTS
Minimum of 3 years of insurance verification experience in a healthcare setting, preferably in a hospital.
                                                           
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
Not applicable

                                                                                                                                                                                  
SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

  1. HIS experience preferred
  2. Microsoft Outlook preferred
  3. Computer skills required.
  4. Ability to manage multiple tasks at one time
  5. Ability to manage a fast-paced environment
  6. Ability to manage multiple phone calls at one time
  7. Strong interpersonal skills, with ability to work effectively with a variety of health professionals.
  8. Knowledge of Medicare, Medicaid and managed care reimbursement methodologies
  9. Proficient in English, written and verbal; excellent communication skills

Equal Employment Opportunity

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.



Company Profile

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.

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