Senior Insurance Authorization Specialist- Neurosurgery (Medical Center)

About the role

The Sr Insurance Authorization Specialist position at Houston Methodist Specialty Physician Group is responsible for obtaining and managing insurance authorizations for medical services, complex procedures and treatments, and complex insurance plans such as CVCP and Transplant. Other duties may include obtaining insurance verification and scheduling of surgical cases.

Responsibilities

• Serves as a liaison between patients, facilities, physicians, and department to ensure timely and accurate authorization of all services/visits.
• Collaborates with internal and external stakeholders to overcome challenges in the authorization process.
• Provides clear and timely updates on authorization status to relevant parties as needed.
• Initiates and manages the authorization process for medical services and simple procedures and treatments.
• Obtains insurance verification and schedules OR cases as needed.
• Maintains accurate and up-to-date records of all authorization requests and approvals.
• Documents communication with insurance providers, healthcare professionals and internal stakeholders.
• Collaborates with healthcare providers to gather necessary documentation for insurance authorization requests.
• Responds promptly to requests and keeps open channels of communication with physicians, patients, and operational partners regarding authorization status and resolution.

Qualifications

• High School diploma or equivalent education.
• Three years of experience working with insurance authorization, preferably in a physician office setting.

Knowledge and Abilities

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing 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 regards 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.
• Mid-level medical terminology and knowledge of insurance requirements for physician visits and procedures.
• 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.
• Service Essential Functions: Initiates and manages the authorization process for medical services and simple procedures and treatments. Obtains insurance verification and schedules OR cases as needed.
• 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.
• 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.
• 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.