Sr Insurance Authorization Specialist - Museum District - Hybrid

At Houston Methodist, the Senior Insurance Authorization Specialist position is responsible for obtaining and managing insurance authorizations for medical services, complex procedures and treatments, and complex insurance plans (i.e. CVCP, Transplant). Other duties may include obtaining insurance verification. This position will utilize effective communication skills in all interactions with patient's, co-workers, insurance companies, physicians, and other clinical and administrative partners.

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

• Three years of experience working with insurance authorization, preferably in a physician office setting

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
• Knowledge of Medicare, Medicaid, and managed care reimbursement methodologies
• Ability to manage multiple tasks 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 volumes
• Working knowledge of CPT and ICD-10 coding conventions 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.
• 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 FUNCTIONS

• Displays initiative to improve job functions. Demonstrates adaptability and flexibility during changing demands.
• Offers suggestions to streamline processes for efficient patient flow.

SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE

• Uniform: No
• Scrubs: No
• Business professional: Yes
• Other (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 Yes
• 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

• Three years of experience working with insurance authorization, preferably in a physician office setting