Transplant Financial Coordinator

Responsibilities

• Advocates for patients and family members and acts as a liaison with insurance companies to assist in obtaining insurance information.
• Obtains detailed benefit information for all aspects of the transplant process from pre transplant through post-transplant care.
• Researches and documents all insurance plans and confirms patients' benefit eligibility, including patient liabilities, clauses, riders, and secondary payors.
• Determines primary and/or other insurance eligibility compliance standards based on predetermined regulations.
• Ability to review, analyze and act upon third party benefit discrepancies prior to billing. Resolves any discrepancies by contacting appropriate patients, family members, employers, etc. as required.
• Advises patients and family members with regards to next steps or processes for securing financial coverage.
• Affords assistance in locating resources and/or assistance programs for which uninsured/underinsured patients may be eligible.
• Provides information to the appropriate billing specialist to ensure accurate billing for current and future services.
• Reviews and interprets insurance group pre-certification requirements.
• Ensures proper pre-authorizations have been obtained.
• Completes any necessary on-line operations for specific payors to complete the pre-certification process.
• As necessary communicates data to utilization management to continue medical review process.
• Coordinates the ongoing pre-certification and approval process with insurance case managers and assists case managers with discharge planning to coordinate the most appropriate level of care for patients.
• Maintains a log of single case agreements and updates patient accounts according to current guidelines and standards.
• Represents Renown Health to external agencies on issues involving transplant admissions, financial policies, and procedures.
• Maintains up to date knowledge base of the changes within the insurance industry and analyzes/update patient accounts according to current guidelines and standards.
• Completes notification and evaluation results form for commercial on-line systems in a timely manner to assure payment.
• Facilitates resolution of patient billing issues related to transplant.
• In conjunction with the social worker acts as a liaison with pharmaceutical companies regarding patient prescription drug coverage and coordinates applications for coverage on the patient's behalf, as necessary.
• Performs payment verification on all transplant cases.
• Attends weekly transplant team meetings to provide patient specific information.
• Accurately maintains required departmental statistical data.

Requirements

• Associate degree or bachelor’s degree preferred.
• Bilingual (Spanish) preferred.
• Two years of patient accounting, medical billing, general medical office, or medical claims processing experience.
• Six months of credit, insurance, governmental program experience and/or direct customer service experience is required.
• Notary Public Certification preferred.