INSURANCE VERIFIER (Part Time Weekdays, 3p-7p)Bookmark This
Houston Methodist Willowbrook Hospital
18220 Tomball Parkway
Work Shift: EVENING
Work Week: M - F
Houston Methodist Willowbrook Hospital opened its doors to Northwest Houston in December 2000. In May 2010, a major expansion on the 52-acre campus doubled the size of the hospital, brining more expertise, more state-of-the-art technology and more specialized care to the community. With 251 licensed beds, 14 operating rooms and over 1,400 employees, Houston Methodist Willowbrook Hospital was specifically designed to provide comprehensive, personalized care for the community.
SUMMARY: The Insurance Verifier is responsible for obtaining, verifying and recording eligibility and benefit information for patients. The incumbent should be able to utilize on-line resources and the phone to obtain and verify the necessary information to provide financial clearance and to successfully secure accounts for elective services. 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 in a timely manner. Competency requirements for computer entry, as well as insurance procedures and collections will be maintained
DUTIES AND RESPONSIBILITIES:
1. Demonstrates excellent skills in obtaining and recording eligibility and benefit information for all patients in the insurance screens (BKKU/INVU) and documenting pertinent notes in account memos (CAAM).
2. Reviews the managed care contract database/matrices for information related to the contract terms and the corresponding estimated patient portion. Notifies the payor of the patient’s admission or procedure in a timely manner, to ensure third party reimbursement.
3. Interviews patients/family members/physician offices to obtain the necessary information to successfully secure the accounts.
4. Refers to the Health Care System’s financial clearance policy as a guideline and collects the appropriate patient portion, co pays and deductibles prior to or on the day of service.
5. Obtains the necessary information and documentation related to the Hospital’s Financial Assistance program, to assist patients who do not qualify for governmental assistance. Provides payment options to patients who do not qualify for financial assistance, utilizing the attached Payment Settlement Policy.
6. Makes physicians and other pertinent parties aware of situation(s) affecting the financial clearance of their patient(s).
7. Serves as the resource person for billing and insurance questions.
8. Alerts management about difficult situations with patients, family members and/or insurance companies, etc. Contributes to departmental and hospital patient satisfaction. Participates in departmental and hospital performance improvement plans.
9. Demonstrates the components of the I CARE values statement (Integrity, Compassion, Accountability, Respect, Excellence).
10. Demonstrates ServicePRIDE standards ( Smile and make eye contact; greet each patient and visitor; seek out patient and visitor contact; displays appropriate body language at all times; take 5 minutes each day to go above and beyond for one patient or visitor; honor diversity; thanks every customer).
11. Follows all safety rules while on the job. Reports accidents promptly and corrects minor safety hazards.
12. Perform other duties as assigned.
EDUCATION REQUIREMENTS: High school diploma or GED equivalent.
EXPERIENCE REQUIREMENTS: Three years experience in healthcare industry with medical terminology required. Two or more years of experience in insurance verification and knowledge of Medicare, Medicaid and managed care reimbursement strategies.
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED: Intermediate experience with Microsoft Office Program (Word, Excel, Outlook). Excellent communication skills in English (Written and Verbal). Knowledge of HBO McKesson – Medipac HIS experience preferred. Ability to work effectively with a variety of health professionals. Ability to multitask and to manage a fast paced environment required.
Equal Employment Opportunity
Equal employment opportunity is a sound and just concept to which Methodist is firmly bound. Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Methodist on the basis of race, color, national origin, religion, sex, physical or mental disability, medical condition, ancestry, marital status, age, sexual orientation, citizenship, genetic information or status as a Vietnam-era veteran or special disabled veteran .