JOB SUMMARY At Houston Methodist, the Outpatient Access Rep is responsible for registration of patients as needed, utilizing the current computerized system. This position is responsible for reviewing patient accounts, verifying insurance benefits and insuring that all required insurance authorizations and pre-certifications are in order for all proposed treatment plans. The position requires communication with physician offices or nursing staff to clarify or correct specific CPT and/or ICD codes with regard to treatment plans and all primary and secondary diagnosis as well as obtain clinical information to validate the use of these codes, using available software for determining medical necessity.
Requirements:
PRIMARY JOB RESPONSIBILITIES Job responsibilities labeled EF capture those duties that are essential functions of the job. PEOPLE - 20%
Coordinates efforts of the patient access staff to efficiently serve this designated area, and maximize effective patient management to help insure appropriate reimbursement. (EF)
Registers new patients and patients returning for additional services utilizing our computerized central registration program in HIS. (EF).
SERVICE - 30%
Identifies and attempts to resolve coding (CPT/ICD) discrepancies and or deficiencies prior to service, to insure proper and maximum reimbursement for services, utilizing software and assistance from Medical Records or clinical staff. Communicates with physician offices and the Cell and/or Gene therapy staff, to obtain any additional clinical information, in an effort to validate treatment plans and codes. (EF)
Insures accurate data entry for patient demographics as well as payor information for submission of claims, to facilitate timely reimbursement. (EF)
Establishes and maintains effective and efficient working relationships with patients, patient families, physicians and their staff, payors, co-workers, and other revenue cycle entities.
QUALITY/SAFETY - 20%
Identifies issues or areas needed for process improvement by reporting issues to the manager and or Director and actively participates in the process.
Follows all safety rules while on the job. Reports accidents promptly and corrects minor safety hazards.
FINANCE - 20%
Reviews accounts at time of check in to insure that all current insurance data is correct and that all required authorizations, pre-certifications, and forms are obtained and are in place prior to treatment and scanned into the system. (EF)
Encounters for reoccurring patients will be reviewed for issues for the purpose of correcting any errors that could result in loss of revenue.
GROWTH/INNOVATION - 10%
Handles all business in professional and confidential manner
Adheres to departmental protocol and policies and procedures.
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.
Qualifications:
EDUCATION REQUIREMENTS
High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
Bachelor's degree relevant to job function is preferred
EXPERIENCE REQUIREMENTS
Three years of experience working in a healthcare environment, including documented experience in admissions, and insurance verification, managed care contracting and or business office is required
CERTIFICATIONS, LICENSES AND REGISTRATIONS REQUIRED
None
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
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
The employee will use independent judgment and experience to accommodate needs of the department and to find ways to positively impact registration and patient access.
Strong computer knowledge will be needed to perform in this position.
Effective use and understanding of medical terminology
Working knowledge of basic CPT/ICD coding requirements
Must be able to function with minimal supervision
SUPPLEMENTAL REQUIREMENTS
Work Attire
Yes/No
Uniform
No
Scrubs
No
Business professional
Yes
Other (dept approved)
No
On-Call*
No (for Non-Exempt or Exempt jobs)
*Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Event, etc) regardless of selection above.
Travel**
May require travel within
Yes
Houston Metropolitan area
May require travel outside
No
of Houston Metropolitan area
**Travel specifications may vary by department.
Please note any other special considerations to this job: __________________________
Company Profile:
Based in the Texas Medical Center, Houston Methodist Hospital is delivering on a mission started in 1919, which continues today - bringing quality, integrity, compassion and innovation into everything we do. As the flagship hospital of Houston Methodist, Houston Methodist Hospital is a nationally recognized medical center with a history of health care innovation. Houston Methodist Hospital was awarded Magnet recognition for nursing excellence for a fourth consecutive time by the ANCC. In addition, Houston Methodist Hospital was recently named by U.S. News & World Report as one of the country's top 20 hospitals and was also ranked the No. 1 hospital in Texas for the fifth consecutive year.
