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Houston Methodist Outpatient Access Rep - PT/OT-Sports Texas City in Texas City, Texas

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.

PATIENT AGE GROUP(S) AND POPULATION(S) SERVED

Refer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.

HOUSTON METHODIST EXPERIENCE EXPECTATIONS

  • Provide personalized care and service by consistently demonstrating our I CARE values:

  • INTEGRITY: We are honest and ethical in all we say and do.

  • COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.

  • ACCOUNTABILITY: We hold ourselves accountable for all our actions.

  • RESPECT: We treat every individual as a person of worth, dignity, and value.

  • EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

  • Focuses on patient/customer safety

  • Delivers personalized service using HM Service Standards

  • Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)

  • Intentionally rounds with patients/customers to ensure their needs are being met

  • Involves patients (customers) in shift/handoff reports byenabling their participation in their plan of care as applicable to the given job

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.

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 AttireYes/No

Uniform No

ScrubsNo

Business professionalYes

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: ________

Houston Methodist Clear Lake Hospital brings the expertise and compassionate care of Houston Methodist Hospital in The Texas Medical Center – a national Honor Roll hospital – to Bay Area communities. The hospital provides a broad spectrum of adult medical and surgical care, is an accredited chest pain center, and is also acute stroke-ready designated through DNV. Houston Methodist Clear Lake offers many inpatient and outpatient services including 3-D mammography and other state-of-the-art imaging, labor and delivery with a level II neonatal ICU, Cancer Center of Excellence, advanced laparoscopic surgery, comprehensive orthopedics and sports medicine, neurology, urology and otolaryngology. Also, Houston Methodist Clear Lake Hospital is honored to be the only hospital in the bay area to have a Grade A rating from Leapfrog Hospital Safety Grading.

Street: 1310 34th St

Name: PT/OT-Sports Texas City

Regular Shift: 1st - Day

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