Financial Coordinator, IVF Center, 20 Hour, Days

Major Responsibilities

• Obtains detailed patient insurance benefit information for all aspects of the medical treatment process including, but not limited to, coverage and network requirements, outpatient prescription drugs, follow-up clinic visits, and travel and housing if necessary.
• Reviews summary plan descriptions. Verifies specific co-pays, deductibles, out of pockets, contract maximum amounts, and outpatient pharmacy coverage for each patient.
• As necessary, coordinates with the contracting department (who obtains the highest reimbursement for services on a case-by-case basis).
• Manage proper course of action for maximum reimbursement of health care charges: spend-down eligibility, cobra coverage, etc.
• Establish contact with case manager at insurer, employers and self-insured groups as needed.
• Obtain insurance pre-certification for patients as necessary.
• Monitors and updates patient insurance data, physicians, authorizations, preferred providers and documents in EMR with required financial guarantor notes.
• Coordinates with physicians and other clinical staff to ensure accurate knowledge of treatment protocols and issues.
• Collaborate with Contracting, Patient Accounts, Physician Billing and Reimbursement, and other departments as necessary to coordinate and facilitate financial process for treatment services.
• Determine eligibility for government assistance programs.
• Calculate and assess discount percentages.
• Establish payment arrangements and settlements appropriately.
• Act as a liaison between patients and insurance companies to assist in the resolution of reimbursement issues.
• Serves as a resource for patients and their family members on financial matters.
• Attends and participates in daily/weekly meetings as necessary.
• Communicates with members of the clinical team, patients, and their families in identifying any potential out-of-pocket expenses.
• Attends seminars and courses on relevant topics, (i.e. Medicare/Medicaid, HMO’s, UNOS, etc.), educating affected areas and applying updated information accordingly for complete compliance of federal regulations.

Position Qualifications

• Licenses/Certifications/Educations Required: Associate Degree.
• Experience/Skills Required: Minimum of 2 years financial experience in a hospital/medical related program. Minimum of 2 years experience in medical insurance. Demonstrates an understanding of insurance industry standards, payor payment methodologies, and managed care concepts. Knowledge of insurance pre-certification and verification. Knowledge of third-party regulatory guidelines. Familiarity with medical terminology. Excellent analytical and communication skills. Knowledge of Medicare/Medicaid.

Physical Demands And Environmental Conditions

• Work is considered sedentary.
• Position requires work indoors in a normal office or patient care environment.