Transplant Financial Coordinator - Full Time - Day

Hackensack Meridian Health•Hackensack, NJ

3d•Onsite

About The Position

Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change. The Transplant Financial Coordinator is a designated member of the Transplant Team (includes physicians, nurses, pharmacists and social workers) and is assigned primary responsibility for coordinating financial aspects of care for transplant candidates, living donors and their families. The Financial Coordinator works with patients and families beginning with the evaluation and continuing through and after the transplantation/donation. The Transplant Financial Coordinator works with multiple payer organizations to determine patient eligibility, coverage, and service and to obtain pre-certification as needed as well as with Finance and other hospital departments to review and authorize payment of appropriate bills.

Requirements

Bachelor's degree in business or health related field or significant job experience (minimum 2 years) in organ transplant with finance specific experience.
Proficient with Advanced Medical Terminology.
Knowledge of CPT transplant coding.
Proficient with Microsoft Office and Google.
Ability to multitask in a fast paced environment.
Excellent problem solving skills.

Nice To Haves

3 years in organ transplant with finance specific experience.
Membership in Transplant Financial Coordinator Association.
Bilingual English/Spanish.

Responsibilities

Obtains, and verifies, detailed patient insurance benefit information, including but not limited to, outpatient prescription drugs, organ acquisition, follow-up clinic visits, and travel and housing if necessary.
Discusses insurance issues and completes a financial review with patients and family members during the initial evaluation. Serves as a resource for patients and family members on financial matters throughout the transplant/donation process.
Works with insurers to verify coverage and obtain payor authorizations for transplant related services.
Maintains a working knowledge of all policies, procedures and criteria for all contracted managed care organizations.
Completes and submits all Requests for Information (RFI) from insurance carriers and/or managed care companies.
In collaboration with Organ Transplant Social Worker, develops a plan to address patient insurance coverage gaps via alternative funding options.
Manages the process of recipient insurance data and authorization to communicate relative information to the Transplant Team members as appropriate throughout the transplant/donation process and during Selection Committee.
Responsible for identifying non-transplant related services and treatment during the global period and excludes these services from the global case rate.
Coordinates the process between Finance and Transplant to ensure accurate dissemination of information, billing and payments, and resolution of issues; in order to insure optimal reimbursement from the cost report, and compliance with CMS rules and guidelines.
Responsible for analyzing and resolving billing errors associated with transplant global and non-global accounts. Coordinates insurance company appeals.
Manages the process associated with invoices from Physicians/Vendors for global patients for appropriate inclusion in global contract rates and ensure the services are billed to the appropriate subaccount.
Adjusts invoices from physician's or facilities to the approved Medicare rates.
Uploads all applicable invoices to PeopleSoft Financials as needed to ensure timely availability for approval by Organ Transplant leadership.
Oversees workflow of all applicable hospital side and physician billing side financial reports and work queues, ensuring all charges and correct and submitted in a timely manner.
Oversees collection of payments and deductibles as required. Maintains reconciliation record of transactions.
Coordinates with nursing staff to obtain insurance authorization for immunomodulating agents for transplant patients.
Coordinates the production of appropriate statistical reports on the Transplant Program as requested.
Other duties and/or projects as assigned.
Adheres to HMH Organizational competencies and standards of behavior.