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.Serves as a liaison between the patient's, facilities, physician's, and department to ensure timely and accurate authorization of all services/visits.Collaborate with internal and external stakeholders to overcome challenges in the authorization process.Provide clear and timely updates on authorization status to relevant parties as needed.
SERVICE ESSENTIAL FUNCTIONS
Initiate and manage the authorization process for medical services and simple procedures and treatments.Maintain accurate and up to date records of all authorization requests and approvals.Document communication with insurance providers, healthcare professionals and internal stakeholders.Collaborate with healthcare providers to gather necessary documentation for insurance authorization requests.Responds promptly to requests and keeps open channels of communication with physician's, patient's and operational partners regarding authorization status and resolution.
QUALITY/SAFETY ESSENTIAL FUNCTIONS
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.Maintains knowledge about insurance regulations, policies, and procedures to ensure compliance with industry standards.
FINANCE ESSENTIAL FUNCTIONS
Utilizes multiple online resources to initiate and verify proper insurance authorization is obtained timely and accurately prior to the patient's scheduled appointment so there is no disruption to patient care/access and/or insurance payments are not denied.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 processes for efficient patient flow.
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
Three years of experience working with insurance authorization, preferably in a physician office 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 principlesKnowledge of Medicare, Medicaid, and managed care reimbursement methodologiesAbility to manage multiple tasks in a fast-paced environmentMid-level medical terminology and knowledge of insurance requirements for physician visits and proceduresAbility to flex hours and work/day assignments to meet needs related to unanticipated patient volumesWorking knowledge of CPT and ICD-10 coding conventions preferred
SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE
Uniform NoScrubs NoBusiness professional YesOther (department approved) Yes
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* Yes
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 Specialty Physician Group - As one of the nation’s leading hospitals and academic medical centers Houston Methodist has brought together some of the nation’s leading experts in multiple specialties to serve our patients. As part of Houston Methodist Specialty Physician Group (HMSPG), these specialists not only provide excellent clinical care, but are on the forefront of research, developing leading-edge technologies and treatments, and teaching the medical pioneers of tomorrow. This combination of clinical service, research and academics ensures patients have access to the latest in treatments and technologies while providing the best in comprehensive patient care. Established as a non-profit corporation and certified by the Texas State Board of Medical Examiners, HMSPG enables physicians to maintain autonomy with respect to their clinical practice while growing their practice within an academic environment.
Options Apply for this job onlineApplyShareEmail this job to a friendRefer Sorry the Share function is not working properly at this moment. Please refresh the page and try again later. Share on your newsfeed Need help finding the right job? We can recommend jobs specifically for you! Click here to get started.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. Application FAQs
Software Powered by iCIMS
www.icims.com