Patient Care Coordinator - Weight Management

At Houston Methodist, the Patient Care Coordinator serves as the initial point of contact for patients, employees, clients, medical staff, and other callers seeking assistance from the department. The Coordinator coordinates physician referrals and appointments, obtains and records eligibility and benefit information for patients receiving services, initiates and tracks insurance authorizations, performs insurance verification and financial clearance, and communicates effectively with patients, coworkers, insurance companies, and physicians.

Non‑exempt

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post‑secondary education, etc.)

• Three years of insurance verification experience in a healthcare setting, preferably in a hospital or clinic setting.

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations.
• Proficient in speaking, reading, and writing the English language necessary to perform the essential functions of this job, particularly with regard to activities impacting patient or employee safety or security.
• Effectively communicates with patients, physicians, family members, and co‑workers in a customer‑service focused manner and applies positive language principles.
• Manages a fast‑paced environment, reviews clinical documentation for medical necessity and payer requirements, and possesses a strong knowledge of medical terminology, CPT, ICD‑10, Medicare, Medicaid, and managed care reimbursement methodologies.
• Works under pressure and balances many competing priorities.
• Adapts to multiple ongoing priorities with minimal supervision, organizes workflow, and actively participates in problem‑solving.

• 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 and seeks management assistance appropriately.
• Contributes to patient, employee, and physician satisfaction, proactively presenting 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 patients of authorization as needed.
• Assists and coordinates various functionality and utilization of patient and client database including data entry; keeps the database up to date.
• Proactively contacts patients and clients to arrange follow‑up on process or outcome goals that are determined or required.

• Coordinates and arranges appointments for providers and patients for meetings, procedures, and appointments, and sends correspondence as designated.
• Communicates to resolve complex patient access and quality service matters, responds promptly to requests, and maintains open channels of communication with physician, patient, and service areas regarding financial clearance status and resolution.
• Initiates authorization for services as needed using clinical information from the ordering physician, monitors and tracks authorizations, and ensures accurate CPT codes, service location, 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.