At Houston Methodist, the Patient Care Coordinator position is responsible for serving as an initial point of contact for patients, employees, clients, medical staff and other callers seeking help from the department. The Patient Care Coordinator performs duties including but not limited to coordinating needed physician referrals and appointments, is responsible for obtaining and recording eligibility and benefit information for patients receiving services and initiates authorization process in a timely manner. This position has the ability to perform more complex processes related to insurance verification, authorization, and financial clearance. The Patient Care Coordinator will also utilize effective communication skills in all interactions with patients, coworkers, insurance companies, physicians etc. This position performs duties including but not limited to coordinating needed physician referrals and appointments, assisting with department initiatives, demonstrating independent actions necessary to provide competent and professional assistance to meet the needs of the healthcare team and patients. This position coordinates, records and transmits information pertinent to the resource management of patients to next level of care providers and performs a wide variety of administrative duties of a higher complexity in support of department operations.
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 insurance verification experience in a healthcare setting, preferably in a hospital or clinic setting
SKILLS 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 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
- Ability to manage a fast-paced environment, to review clinical documentation for Medical Necessity and payer requirements, and have a high level and knowledge of medical terminology, CPT, International Classification of Diseases ICD-10 preferred. Knowledge of Medicare, Medicaid, and managed care reimbursement methodologies
- Ability to work under pressure and balance many competing priorities
- Adapts to multiple ongoing priorities with minimal supervision, including organizing workflow and actively participating in problem-solving
ESSENTIAL FUNCTIONS
PEOPLE ESSENTIAL FUNCTIONS
- Answers incoming telephone calls, troubleshoots and directs calls and requests to appropriate individuals from patients, employees and clients while evaluating, documenting and managing their needs. Proactively acts as a patient advocate, responding to and working to resolve patient concerns.
- Supports patients, coworkers, insurance companies, physicians, etc., with questions regarding pending authorizations and eligibility/benefit information for patients receiving services. Assists other team members (e.g., Patient Service Coordinator, account integrity) 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.
- Assists and coordinates various functionality and utilization of patient and client database including data entry; assuring database is kept up-to-date. Proactively contacts patients and clients to arrange follow-up on process or outcome goals that are determined or required.
SERVICE ESSENTIAL FUNCTIONS
- Coordinates and arranges appointments for providers and patients for patient meetings, procedures, and appointments and sends correspondence as designated. Assists with clerical functions for patients and clients, coordinating referrals and services, following department standards.
- 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.
- 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.
- 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.
QUALITY/SAFETY ESSENTIAL FUNCTIONS
- Conducts 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). Providing expert-level analysis of accounts and completes high-quality work while adhering to productivity standards.
- Maintains knowledge about insurance regulations, policies, and procedures to ensure compliance with industry standards. 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.
FINANCE ESSENTIAL FUNCTIONS
- Utilizes resources with cost effectiveness and value creation in mind. Self-motivated to independently manage time effectively minimizing incidental overtime, prioritize daily tasks, and assisting coworkers as needed.
- Utilizes multiple online resources to coordinate the initiation and verification of insurance authorization. Obtaining 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.
- 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. Providing expert-level analysis of accounts and completes high-quality work while adhering to productivity standards.
GROWTH/INNOVATION ESSENTIAL FUNCTIONS
- Seeks opportunities to identify self-development needs and takes appropriate action. Ensures own career discussions occur with appropriate management. Completes and updates the My Development Plan (MDP) on an ongoing basis.
SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE
- Uniform: No
- Scrubs: No
- Business professional: Yes
- Other (department approved): No
ON-CALLNote that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.
TRAVELTravel 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 insurance verification experience in a healthcare setting, preferably in a hospital or clinic setting
Company Profile:
Houston Methodist is one of the nation's leading health systems and academic medical centers. The health system consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the Texas Medical Center, seven community hospitals and one long-term acute care hospital throughout the Greater Houston metropolitan area. Houston Methodist also includes a research institute; a comprehensive residency program; international patient services; freestanding comprehensive care clinics, emergency care and imaging centers; and outpatient facilities. Come lead with us!
Houston Methodist is an Equal Opportunity Employer.