Insurance Verifier

At Houston Methodist, the Insurance Verifier position is responsible for obtaining and recording eligibility and benefit information for patients receiving services, confirming authorizations, and completing admission notifications as applicable to the department. Other duties may include calculating patient liability and generating estimates to determine patient financial responsibility. This position will also utilize effective communication skills in all interactions with patients, co‑workers, insurance companies, physicians, etc. FLSA STATUS Non‑exempt QUALIFICATIONS Education High School diploma or equivalent education (e.g., GED, verification of homeschool equivalency, partial or full completion of post‑secondary education). Experience One year of healthcare experience that includes insurance verification, preferably in a hospital or clinic setting. Skills and Abilities Demonstrates necessary skills and competencies to safely perform the assigned job, determined through ongoing assessments. Proficient in English, both spoken and written, for essential job functions. Ability to effectively communicate with patients, physicians, family members, and co‑workers in a customer‑service focus. Proficiency with Microsoft Office components (Outlook, Word) and knowledge of electronic health record software (EPIC preferred). Knowledge of Medicare, Medicaid, and managed care reimbursement methodologies. Ability to manage multiple tasks simultaneously and in a fast‑paced environment. Mid‑level medical terminology and knowledge of insurance requirements for physician visits and procedures. Ability to flex hours and work/day assignments to meet needs related to unanticipated patient volume. Working knowledge of CPT, ICD‑9 and/or ICD‑10 preferred. ESSENTIAL FUNCTIONS 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 resolves access to care issues. Serves as a liaison between patients, the facility, physicians, and the department to ensure timely and accurate financial clearance of all accounts. Communicates with scheduling to inform patients 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, ensuring accurate CPT codes, location of service, and expiration dates. Communicates to resolve patient access and quality service matters; responds promptly to requests and maintains open channels of communication with physicians, patients, 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. 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 and documentation guidelines. 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 Functions Displays initiative to improve job functions and demonstrates adaptability during changing demands. Offers suggestions to streamline processes for efficient patient flow. Participates in department or entity/system‑wide projects and activities; seeks opportunities for continuous development. SUPPLEMENTAL REQUIREMENTS Work Attire Uniform: No Scrubs: No Business professional: Yes Other (department approved): No On‑Call On Call: No (employees may be required to be on‑call during emergencies regardless of selection). Travel May require travel within the Houston Metropolitan area: Yes May require travel outside Houston Metropolitan area: No #J-18808-Ljbffr