Refer 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 ModelDelivers personalized service using HM Service StandardsProvides 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 jobDisplays cultural humility, diversity, equity and inclusion principlesActively 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.
GROWTH/INNOVATION ESSENTIAL FUNCTIONSDisplays initiative to improve job functions. Demonstrates adaptability and flexibility during changing demands. Offers suggestions to streamline process for efficient patient flow.Participates in various department and/or entity/system-wide projects and activities. Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development.
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 responsibilities as the need arises. Qualifications EDUCATION
High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
WORK EXPERIENCE
One year of healthcare experience which must have included insurance verification, preferably in a hospital or clinic setting License/Certification LICENSES AND CERTIFICATIONS - REQUIRED
N/A KSA/ Supplemental Data KNOWLEDGE, SKILLS, AND ABILITIES
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluationsSufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or securityAbility to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principlesProficiency in Microsoft office components (e.g., Outlook, Word) and knowledge of electronic health record software (EPIC preferred)Knowledge of Medicare, Medicaid, and managed care reimbursement methodologiesAbility to manage multiple tasks at one timeMid-level medical terminology and knowledge of insurance requirements for physician visits and proceduresAbility to manage a fast-paced environmentAbility to flex hours and work/day assignments to meet needs related to unanticipated patient volumeWorking knowledge of CPT, International Classification of Diseases (ICD)-9 and/or ICD-10 preferred
SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE
Uniform NoScrubs NoBusiness professional YesOther (department approved) No
ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.
On Call* No
TRAVEL**
**Travel specifications may vary by department**
May require travel within the Houston Metropolitan area YesMay require travel outside Houston Metropolitan area No Company Profile
Houston Methodist Clear Lake Hospital brings the expertise and compassionate care of Houston Methodist Hospital in The Texas Medical Center – a national Honor Roll hospital – to Bay Area communities. The hospital provides a broad spectrum of adult medical and surgical care, is an accredited chest pain center, and is also acute stroke-ready designated through DNV. Houston Methodist Clear Lake offers many inpatient and outpatient services including 3-D mammography and other state-of-the-art imaging, labor and delivery with a level II neonatal ICU, Cancer Center of Excellence, advanced laparoscopic surgery, comprehensive orthopedics and sports medicine, neurology, urology and otolaryngology. Also, Houston Methodist Clear Lake Hospital is honored to be the only hospital in the bay area to have a Grade A rating from Leapfrog Hospital Safety Grading.
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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. Application FAQs
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