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.
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.
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.
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
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
LICENSES AND CERTIFICATIONS - REQUIRED
N/A
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 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
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
Company Profile:
Houston Methodist is one of the nation's leading health systems and academic medical centers. Houston Methodist consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center, and seven community hospitals throughout the greater Houston area. Houston Methodist also includes an academic institute, a comprehensive residency program, a global business division, numerous physician practices and several free-standing emergency rooms and outpatient facilities. Overall, Houston Methodist employs more than 27,000 employees and is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide high quality patient care.
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.
