At Houston Methodist, the Reimbursement Coordinator position is responsible for maximizing reimbursement opportunities within the pharmacy department and hospital. This position performs activities that include but are not limited to drug replacement programs, co-pay assistance programs, insurance verification for high-cost drugs and/or restricted drugs, and denial prevention management. This position also maintains data/documents and provides accounting of results.

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 Model

• 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 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 job

• Displays cultural humility, diversity, equity and inclusion principles

• Actively supports the organization's vision, fulfills the mission and abides by the I CARE values

PEOPLE ESSENTIAL FUNCTIONS

• Promotes a positive work environment and contributes to a dynamic, team-focused work unit that actively helps one another to achieve optimal department results. Collaborates with other health care professionals as needed for problem resolution and/or achievement of identified patient specific goals.

• Establishes business relationships with appropriate hospital financial staff and other pertinent hospital departments as required.

SERVICE ESSENTIAL FUNCTIONS

• Maintains and updates changes for patients participating in the assistance medication recovery program.

• Develops and maintains all components of the reimbursement process, including key hospital departments.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Assists with the development of drug recovery reimbursement policies and procedures pertinent to the area drug recovery.

• Ensures all drug recovery received is properly documented; maintains files and documentation of claim submittals.

FINANCE ESSENTIAL FUNCTIONS

• Monitors trends and reasons for denied claims and takes action to resolve issues that interfere with drug recovery reimbursement.

• Maintains database comprised of receivables, problems, standard forms, letters and manufacturers that offer medication patient assistance reimbursement programs.

• Tracks, documents, and reports cost savings associated with patient assistance drug recovery programs, and provides updates to pharmacy management on medication reimbursement opportunities.

• Optimizes reimbursement opportunities through insurance verification of high-cost drugs.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Identifies opportunities to enhance the prior authorization process and opportunities to increase cost-savings for patients.

• Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development as a Reimbursement Coordinator.

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

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

WORK EXPERIENCE

• Four years of relevant experience in areas such as pharmacy, clinical documentation, coding, social services, scheduling, insurance and/or patient accounting

LICENSES AND CERTIFICATIONS - REQUIRED

• N/A

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 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

• Significant planning, problem solving, and complex decision making skills to ensure optimized financial outcomes

• Proficient computer knowledge and computer systems such as MS Word and Excel; proficiency in Health Information Management Systems, and SPSS or SAS is preferred

• Exhibits strong interpersonal and team player skills with all levels of the healthcare team and assures delivery of excellent customer service to all patients, visitors, physicians and co-workers

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform No
• Scrubs Yes
• Business professional Yes
• Other (department approved) Yes

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 Yes
• May require travel outside Houston Metropolitan area No

Houston Methodist (HM) is one of the nation’s leading health systems and academic medical centers.  HM consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center, and seven community hospitals throughout the greater Houston metropolitan area.  HM also includes an academic institute, a comprehensive residency program, a global business division, numerous physician practices and several free-standing emergency rooms and outpatient facilities.  Overall, HM employs over 25,000 employees.   Houston Methodist is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide the best patient care and service in a spiritual environment.

In 2019 Houston Methodist and its physicians treat more than 6,333 international patients from more than 76 countries. Houston Methodist Global Health Care Services’ consulting and education divisions also provide advisory services and training and development to health care organizations around the world.