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.Practices the Caring and Serving ModelDelivers personalized service using HM Service StandardsProvides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience.Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given jobDisplays cultural humility, diversity, equity and inclusion principlesActively supports the organization's vision, fulfills the mission and abides by the I CARE values Responsibilities PEOPLE ESSENTIAL FUNCTIONS
Serves as a department resource for questions related to case management activities. Communicates in an active, positive, and effective manner to all interprofessional health care team members. Reports pertinent patient care and family data in a comprehensive and unbiased manner. Performs phone call and communication triage, troubleshoots and routes issues to appropriate individuals, assists in resolution of non-clinical issues as neededFacilitates and arranges acquisition of post-acute needs, as directed, and in collaboration with the clinical team. Follows payor/reimbursement practices and regulations that may impact the patient's plan of careProvides appropriate and timely communication, update, and documentation to the referring personnel to keep them informed of the status of the requestConducts self in a manner that is congruent with cultural diversity, equity, and inclusion principles. Contributes towards improvement of department scores for employee engagement, i.e., peer-to-peer accountability
SERVICE ESSENTIAL FUNCTIONS
Assists the department in distributing required notices, including the Medicare Notice of Discharge to patients, securing signatures on the form from the patient or their legal representative, and answering questions regarding the appeal processDistributes the Medicare Notice of Discharges to identified patients, including capturing patient and their legal representative's signatures, answering any questions regarding the appeal processCoordinates with the clinical staff to prioritize placement requests. Provides necessary documentation to facilitate post-acute servicesAssists with clerical and clinical functions for patients, physicians, and staff. Provides administrative support as needed, including scheduling follow-up appointments, and confirming the provision or delivery or post-acute services or equipment
QUALITY/SAFETY ESSENTIAL FUNCTIONS
Participates in quality improvement initiatives and collects data for use in department performance improvement as directed. Maintains timelines for follow up and prioritization of department projects and tasksUpdates and maintains resources, information and database or directories elated to post-acute providers and insurance contacts to facilitate timely communication and coordination as needed
FINANCE ESSENTIAL FUNCTIONS
Informs social worker/case manager of the patients' available benefits through insurance/managed care provider. Assists in providing community resources/services to uninsured patients as requested Case Management staffParticipates in reimbursement/certification and authorization-related activities as directed. Documents approvals and authorization numbers from payors. Logs communications and provides information to social workers and case managers, business office/patient access, etc. on insurance/managed care benefitsSupports and assists with concurrent insurance denials and appeals process, transmission of utilization reviews to insurance companies, coordination of peer discussions as directed by the clinical team. Documents authorization, approvals, and denials
GROWTH/INNOVATION ESSENTIAL FUNCTIONSMaintains awareness of payor/reimbursement practices and regulations that may impact patient's plan of care and confers with care coordinators and social workers to prioritize placement requestsSeeks 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 on an on-going basis
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
High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)Associate degree preferred
WORK EXPERIENCE
Two years of experience in any of the following: service recovery, insurance verification, working with patient information, having patient contact, and/or general health care coordination responsibilities within a healthcare environmentPrevious experience in hospital setting and/or Case Management License/Certification LICENSES AND CERTIFICATIONS - REQUIRED
N/A KSA/ Supplemental Data KNOWLEDGE, SKILLS, AND ABILITIES
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluationsSufficient 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 securityAbility 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 principlesSome knowledge of community resourcesMust be able to operate within a Microsoft Office environment. Proficiency in MS Outlook and MS Word/Excel, knowledge of Medical TerminologyExcellent telephone, oral and written communication skills, time management and prioritization skillsAble to learn new skills effectivelyAbility to work independently while collaborating with other team members and exercise sound judgment in interactions with physicians, payors, and patients and their familiesStrong organizational and problem-solving skills
SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE
Uniform NoScrubs NoBusiness professional YesOther (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 NoMay require travel outside Houston Metropolitan area No Company Profile
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.
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Houston Methodist is an Equal Opportunity Employer.
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