Infusion Insurance Liaison

At Houston Methodist, the Infusion Insurance Liaison position is responsible for obtaining insurance authorizations for patients who receive infusion services including those with a diagnosis of cancer requiring complex long-term management for individualized treatment plans. This position works closely with the healthcare team and pharmacy to ensure initial treatments and changes in treatment are financially cleared while utilizing effective communication skills in all interactions with patients, co-workers, insurance companies and healthcare clinical team.

This position will be part of the infusion/oncology team, so experience in this space is highly preferred. This role is also eligible for work from home opportunity (within greater Houston area) once training has been complete.

FLSA STATUS
Non-exempt

QUALIFICATIONS

EDUCATION

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)

EXPERIENCE

• Four years of insurance authorization experience in a healthcare setting; may consider a HM employee with one year less authorization experience
• Experience with infusion authorizations preferred

SKILLS AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
• Sufficient 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 security
• Ability 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 principles
• Strong customer service and phone skills
• Basic computer skills in word processing applications and ability to utilize software systems such as the electronic medical record
• Knowledge of basic medical terminology
• Ability to analyze and solve problems
• Working knowledge of revenue cycle components and insurance requirements for reimbursement

ESSENTIAL FUNCTIONS

PEOPLE ESSENTIAL FUNCTIONS

• Contributes to a positive work environment and to a dynamic, team focused work unit that actively helps one another to achieve optimal department results. Collaborates with all members of the interprofessional health care team by actively communicating and reporting pertinent patient care information and data in a comprehensive manner.
• Serves as a liaison for the patient, medical staff, and insurance companies. Communicates to resolve patient access and quality service matters. Keeps open channels of communication with physician, patient, and service areas regarding action taken and resolution.
• Trains and mentors new team members.

SERVICE ESSENTIAL FUNCTIONS

• Completes financial clearance activities including obtaining insurance authorizations for complex individualized treatments which may extend over long periods of time with frequent modifications. Monitors and tracks authorizations, including ensuring accurate Current Procedural Terminology (CPT) codes, location of service performed, expiration dates and number of treatments performed.
• Uses excellent communication skills (verbal, non-verbal, written) to facilitate providing the highest quality service during every patient, physician, guest, employee, or other encounter. Responds promptly to requests by staff, patients, physicians, and other members of the patient care team. Recognizes and responds appropriately to urgent/emergent situations per protocols.
• Provides appropriate notification of issues that may result in service delays or denials. Handles add-ons and treatment changes appropriately and as per department protocol.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Enters patient and authorization data into the electronic medical record system with a high level of thoroughness, accuracy and timeliness. Documents detailed treatment authorization outcomes, including timelines and treatment counts to ensure re-authorization is obtained as needed.
• Ensures patient information is conveyed to others appropriately while complying with patient confidentiality and Health Insurance Portability and Accountability Act (HIPAA) regulations.

FINANCE ESSENTIAL FUNCTIONS

• Utilizes multiple online resources to initiate and verify authorization needed for prompt submission. Notifies the payer of the patient’s admission or procedure in a timely manner to ensure third party reimbursement.
• Organizes time effectively, minimizing incidental overtime, and sets priorities. Adheres to productivity standards.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Displays initiative to improve job functions; offers suggestions to streamline processes and utilizes increased insurance job knowledge to ensure the latest healthcare policies are applied to financial clearance.
• Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development.

SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE

• Uniform: No
• Scrubs: No
• Business professional: Yes
• Other (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 No
• May require travel outside Houston Metropolitan area No

QUALIFICATIONS

EDUCATION

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)

EXPERIENCE

• Four years of insurance authorization experience in a healthcare setting; may consider a HM employee with one year less authorization experience
• Experience with infusion authorizations preferred