Sr Insurance Verifier
Houston Methodist · Houston, TX · 1 mo ago
OTHRFull-time
We need to output HTML fragment with headings for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. We must not repeat job title as heading. Must not include Job ID etc. Remove boilerplate like EEO, etc. Must preserve all substantive info.
We need to parse the posting: It starts with "Come lead with us at Houston Methodist Hospital At Houston Methodist, the Senior Insurance Verifier position is responsible for obtaining and recording eligibility and benefit information for patients receiving services and initiates the admission notification and authorization process in a timely manner. The Senior Insurance Verifier communicates to resolve patient access and quality service matters and demonstrates an ability to perform more complex processes related to insurance verification, authorization, and financial clearance. This position will also utilize effective communication skills in all interactions with patients, co-workers, insurance companies, physicians etc."
That's about the role. So we can have
for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. We must not repeat job title as heading. Must not include Job ID etc. Remove boilerplate like EEO, etc. Must preserve all substantive info.
We need to parse the posting: It starts with "Come lead with us at Houston Methodist Hospital At Houston Methodist, the Senior Insurance Verifier position is responsible for obtaining and recording eligibility and benefit information for patients receiving services and initiates the admission notification and authorization process in a timely manner. The Senior Insurance Verifier communicates to resolve patient access and quality service matters and demonstrates an ability to perform more complex processes related to insurance verification, authorization, and financial clearance. This position will also utilize effective communication skills in all interactions with patients, co-workers, insurance companies, physicians etc."
That's about the role. So we can have About the role
with paragraph(s) summarizing that.
Then we have FLSA STATUS Non-exempt (maybe not needed as heading; could be a short paragraph under About the role or maybe under Qualifications? It's metadata; we can fold into a short
maybe. Then QUALIFICATIONS EDUCATION High School diploma or equivalent... EXPERIENCE Three years of insurance verification experience... etc. Then SKILLS AND ABILITIES list many bullet-like statements. Then ESSENTIAL FUNCTIONS broken into categories: PEOPLE ESSENTIAL FUNCTIONS, SERVICE ESSENTIAL FUNCTIONS, QUALITY/SAFETY ESSENTIAL FUNCTIONS, FINANCE ESSENTIAL FUNCTIONS, GROWTH/INNOVATION ESSENTIAL FUNCTIONS. Those are responsibilities/duties. So we can put under
Responsibilities
a- list of duties.
We need to preserve all substantive info; we can combine similar items.
We must not include sections like Benefits, Pay, Schedule unless posting actually states them. The posting does not mention benefits, pay, schedule. So we omit those sections.
We need to include Qualifications? The posting has QUALIFICATIONS heading with EDUCATION, EXPERIENCE. Also there is a separate SKILLS AND ABILITIES. Could treat Qualifications as education+experience, and Skills as separate section. Or combine into Requirements? The instruction says use headings like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. So we can have Qualifications for education/experience, Skills for skills and abilities, Requirements maybe for other requirements like FLSA status? But we can decide to include only those with content.
We have FLSA STATUS Non-exempt (maybe under Qualifications or Requirements). Also SUPPLEMENTAL REQUIREMENTS includes WORK ATTIRE, ON-CALL, TRAVEL. Those are supplemental requirements. Could be under Requirements.
We need to preserve all substantive info: So include details about uniform, on-call, travel.
Thus sections:
- About the role (paragraph)
- Responsibilities (list of essential functions across categories)
- Qualifications (education, experience)
- Skills (skills and abilities)
- Requirements (FLSA status, supplemental requirements: work attire, on-call, travel)
We should not include Benefits, Pay, Schedule.
We must not repeat job title as heading. Good.
We must not include boilerplate like EEO etc. At end there is "Houston Methodist is an Equal Opportunity Employer." Remove.
Also remove duplicated lines: The experience line appears twice; we should include only once.
Now craft HTML.
We need to use
for each section heading. Use
for prose. Use
- for lists.
We need to preserve all substantive info: Let's extract.
About the role paragraph: Combine first sentences.
"Come lead with us at Houston Methodist Hospital At Houston Methodist, the Senior Insurance Verifier position is responsible for obtaining and recording eligibility and benefit information for patients receiving services and initiates the admission notification and authorization process in a timely manner. The Senior Insurance Verifier communicates to resolve patient access and quality service matters and demonstrates an ability to perform more complex processes related to insurance verification, authorization, and financial clearance. This position will also utilize effective communication skills in all interactions with patients, co-workers, insurance companies, physicians etc."
We can maybe trim redundant "At Houston Methodist" duplication but keep meaning.
Now Responsibilities: list all essential functions.
From 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.
- Supports Insurance Verifiers with questions regarding pending authorizations and eligibility/benefit information for patients receiving services.
- Assists other team members (e.g., registration, financial counseling) as directed by management.
- Seeks management assistance appropriately.
- Contributes to patient, employee, and physician satisfaction.
- Proactively presents solutions to resolve access to care issues when possible.
- Serves as a liaison between the patients, facility, physicians, and department to ensure timely and accurate financial clearance of all accounts.
- Communicates with scheduling to inform patient of authorization as needed.
- Trains and mentors new team members.
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.
- Assists with resolving electronic health record (EHR) work queues that support insurance verification.
- Generates reports and assists with department correspondence as directed.
- Initiates authorization for services as needed utilizing clinical information provided by the ordering physician.
- Monitors and tracks authorizations, including ensuring accurate Current Procedural Terminology (CPT) codes, location of service performed and expiration dates.
- Communicates to resolve complex patient access and quality service matters.
- Responds promptly to requests and keeps open channels of communication with physician, patient, and service areas regarding financial clearance status and resolution.
- Communicates openly in a non-judgmental and professional demeanor during all interactions with customers and co-workers.
- 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 in the appropriate system(s) and screen(s)/field(s) within the system(s).
- 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.
- Provides expert level analysis of accounts and completes high-quality work while adhering to productivity standards.
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.
- 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.
- Generates and communicates new ideas and suggestions that will improve quality or service.
- Offers suggestions to streamline process for efficient patient flow.
- Participates in various department and/or entity/system-wide projects and activities.
- Demonstrates adaptability and flexibility during changing demands.
- Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development.
Now Qualifications: Education and Experience.
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 insurance verification experience in a healthcare setting, preferably in a hospital or clinic setting
We should not duplicate experience line.
Now Skills: list from 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
- Proficiency in Microsoft office components (e.g., 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 at one time
- Understands medical terminology at a high level and has knowledge of insurance requirements for physician visits and procedures
- Ability to manage a fast-paced environment
- Ability to flex hours and work/day assignments to meet needs related to unanticipated patient volume
- Ability to review clinical documentation for Medical Necessity and payer requirements
- Working knowledge of CPT, International Classification of Diseases (ICD)-9 and/or ICD-10 preferred
Now Requirements: FLSA STATUS Non-exempt, 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 Yes May require travel outside Houston Metropolitan area No
We need to present these as a short paragraph or list. Probably a
- for each supplemental requirement.
We can phrase:
- FLSA status: Non-exempt
- Work attire: Business professional required; uniforms and scrubs not required.
- On-call: Not required, but employees may be required to be on-call during emergencies (e.g., disaster, severe weather events).
- Travel: May require travel within the Houston metropolitan area; no travel outside the Houston metropolitan area required.
Now ensure we didn't miss any substantive info: The phrase "FLSA STATUS Non-exempt" we captured. The supplemental requirements we captured.
Now we need to output only HTML fragment, no markdown fences.
Let's craft.
We'll have:
About the role
...
Responsibilities
- ... ...
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 insurance verification experience in a healthcare setting, preferably in a hospital or clinic setting
Skills
- ... ...
Requirements
- FLSA status: Non-exempt
- Work attire: Business professional required; uniforms and scrubs not required.
- On-call: Not required as a regular duty, but employees may be required to be on-call during emergencies (e.g., disaster, severe weather events).
- Travel: May require travel within the Houston metropolitan area; no travel outside the Houston metropolitan area required.
- for each supplemental requirement.
We can phrase:
- FLSA status: Non-exempt
- Work attire: Business professional required; uniforms and scrubs not required.
- On-call: Not required, but employees may be required to be on-call during emergencies (e.g., disaster, severe weather events).
- Travel: May require travel within the Houston metropolitan area; no travel outside the Houston metropolitan area required.
Now ensure we didn't miss any substantive info: The phrase "FLSA STATUS Non-exempt" we captured. The supplemental requirements we captured.
Now we need to output only HTML fragment, no markdown fences.
Let's craft.
We'll have:
- for lists.
We need to preserve all substantive info: Let's extract.
About the role paragraph: Combine first sentences.
"Come lead with us at Houston Methodist Hospital At Houston Methodist, the Senior Insurance Verifier position is responsible for obtaining and recording eligibility and benefit information for patients receiving services and initiates the admission notification and authorization process in a timely manner. The Senior Insurance Verifier communicates to resolve patient access and quality service matters and demonstrates an ability to perform more complex processes related to insurance verification, authorization, and financial clearance. This position will also utilize effective communication skills in all interactions with patients, co-workers, insurance companies, physicians etc."
We can maybe trim redundant "At Houston Methodist" duplication but keep meaning.
Now Responsibilities: list all essential functions.
From 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.
- Supports Insurance Verifiers with questions regarding pending authorizations and eligibility/benefit information for patients receiving services.
- Assists other team members (e.g., registration, financial counseling) as directed by management.
- Seeks management assistance appropriately.
- Contributes to patient, employee, and physician satisfaction.
- Proactively presents solutions to resolve access to care issues when possible.
- Serves as a liaison between the patients, facility, physicians, and department to ensure timely and accurate financial clearance of all accounts.
- Communicates with scheduling to inform patient of authorization as needed.
- Trains and mentors new team members.
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.
- Assists with resolving electronic health record (EHR) work queues that support insurance verification.
- Generates reports and assists with department correspondence as directed.
- Initiates authorization for services as needed utilizing clinical information provided by the ordering physician.
- Monitors and tracks authorizations, including ensuring accurate Current Procedural Terminology (CPT) codes, location of service performed and expiration dates.
- Communicates to resolve complex patient access and quality service matters.
- Responds promptly to requests and keeps open channels of communication with physician, patient, and service areas regarding financial clearance status and resolution.
- Communicates openly in a non-judgmental and professional demeanor during all interactions with customers and co-workers.
- 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 in the appropriate system(s) and screen(s)/field(s) within the system(s).
- 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.
- Provides expert level analysis of accounts and completes high-quality work while adhering to productivity standards.
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.
- 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.
- Generates and communicates new ideas and suggestions that will improve quality or service.
- Offers suggestions to streamline process for efficient patient flow.
- Participates in various department and/or entity/system-wide projects and activities.
- Demonstrates adaptability and flexibility during changing demands.
- Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development.
Now Qualifications: Education and Experience.
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 insurance verification experience in a healthcare setting, preferably in a hospital or clinic setting
We should not duplicate experience line.
Now Skills: list from 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
- Proficiency in Microsoft office components (e.g., 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 at one time
- Understands medical terminology at a high level and has knowledge of insurance requirements for physician visits and procedures
- Ability to manage a fast-paced environment
- Ability to flex hours and work/day assignments to meet needs related to unanticipated patient volume
- Ability to review clinical documentation for Medical Necessity and payer requirements
- Working knowledge of CPT, International Classification of Diseases (ICD)-9 and/or ICD-10 preferred
Now Requirements: FLSA STATUS Non-exempt, 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 Yes May require travel outside Houston Metropolitan area No
We need to present these as a short paragraph or list. Probably a