Transplant Financial Coordinator - Transplant Administration - Frost Street - Day - Full Time

Sharp Healthplan•San Diego, CA

66d•$26 - $37

About The Position

The Transplant Financial Coordinator plays an integral role in assisting patients with the critical function of financial planning for their transplant surgery, VAD implant, and future medical needs as well as assuring transplant department billing compliance. The primary responsibility of the Transplant Financial Coordinator is assessing patient's insurance coverage and financial situation for transplantation and immunosuppressant drug coverage. The Transplant Financial Coordinator is also a key member of the transplant program and must provide up to date and accurate input on patient financial clearance for transplantation and VAD implants during department staff meetings, selection meetings, huddles, etc.

Requirements

H.S. Diploma or Equivalent
5 Years Experience in medical billing (hospital and/or professional), processing financial transactions and/or finance related field
Working knowledge of third party payer verification terminology.
Working knowledge in the functional operations of third-party payors and utilization review agencies to expeditiously coordinate follow-up.
Working knowledge of State and Federal programs to ensure reimbursement from Medicare, Medi-Cal, CCS programs, out-of-state Medicaid, or other sponsoring agencies.
Working knowledge of health plans with special processing requirements for emergency patients and ability to effectively communicate these requirements to physicians and administrative personnel under time urgent conditions.
Ability to attend to many details within a short span of time.
Working knowledge of HMO's and PPO's.
Skill in analyzing information, problems, situations, practices or procedures in order to define the problem/objective; identify relevant concerns/factors; identify patterns, tendencies or relationships; formulate logical and objective conclusions; recognize alternatives and their implications.
Thorough knowledge of medical terminology and coding.
Working knowledge of healthcare and insurance authorization process.
Excellent telephone etiquette and ability to work with a diverse interdisciplinary team.
Proficiency skilled with Microsoft Office, PowerPoint, Excel, Outlook, etc.

Nice To Haves

Associate's Degree
Transplant financial counseling and billing experience.
Advanced knowledge of medical billing, reimbursement and collections processes is preferred.
Advanced knowledge of healthcare and transplant terminology is preferred.
Knowledge of transplant billing requirements is preferred.

Responsibilities

Serves as an exemplary customer service role model by demonstrating a positive, caring attitude to all patients, guests, fellow Sharp HealthCare employees, external contacts, and physicians while promoting teamwork in the accomplishment of Department and Hospital goals.
Assists Team Leader with staff development in customer relations by increasing employee awareness when areas for improvement are observed. Identifies and recommends methods that would improve existing service and opportunities for service recovery.
Meets with transplant candidate, potential living donors and/or family to explain insurance coverage, treatment costs, and hospital billing policies. Ensures that adequate insurance benefits or funding arrangements are in place prior to transplant. Consistently document all interactions with patients and family members.
Provides quality service to patients by providing comprehensive and ongoing financial counseling. Serves as a resource to transplant candidates and their families and living donors regarding transplant payor benefits, billing issues, alternative funding options, and personal financial responsibilities regarding the transplant.
Assists transplant candidates in meeting expenses for transplants by providing guidance on fundraising, completion of Medicare/Medicaid/disability applicants, indigent funding, etc.
Perform post-transplant billing counseling services to patients, including discussion of benefits and financial concerns. Confirm patient post-transplant insurance coverage, obtain, verify, and update insurance, financial, statistical, and demographic information.
Is at workstation, ready to work, from scheduled start time through end of shift, except for designated breaks.
Assists in other finance transplant areas to relieve temporary backlogs in work flow. Accepts new assignments, changing workloads, schedule changes, and/or deviations from standard work days with a positive attitude, assisting with the smooth transition and/or implementation of new and existing procedures.
Prepare and attend transplant selection committee meeting; present and discuss financial issues pertaining to patients that are being presented for transplant listing and surgeries.
Complete all other job duties as assigned by direct management.
Obtains and documents detailed patient insurance benefit information for all phases of the transplant process, including, but not limited to, outpatient prescription drugs, organ acquisition, follow-up Clinic visits, and travel and lodging, if necessary.
Obtains all necessary authorizations from payers. Verifying transplant coverage and other medical benefits and obtaining referrals and authorizations if required
Obtains all necessary information, including clinical documentation, required by payors for approval of different transplantation phases, including benefit verification, payor authorization, referrals, precertification, and case management.
Communicate with appropriate clinical staff the status of ongoing payer requests, denials and/or potential denials for non-covered services and other problems; initiate communication with appropriate agencies and clinical staff for appeal of denials; Conduct required follow-up on all initiated prior authorizations in an effort to obtain the final authorization.
Verifies the accuracy and completeness of relevant financial, insurance, and or demographic information for transplant related outpatient encounters and the inpatient transplant admission to ensure that accounts are secure prior to discharge.
Complete Inpatient admission notification for urgent or planned admissions. Coordinate with the Utilization Management department to facilitate patient admission/discharge information to fulfill insurance carrier requirements.
Establishes and maintains a working relationship with key contacts at insurance companies (i.e., case managers, medical directors).
Collaborate with clinical team to communicate changes in pre-authorization, denial, medical review, appeals, managed care contracts, and referrals to ensure timely process of financial clearances to avoid high dollar denials.
Completion of the Medicare 2728 Form for post-transplant eligible patients, as well as assistance with Medicare enrollment applications.
In conjunction with the Team Leader, assures complete and accurate insurance information is obtained on all transplant patients and maintains current transplant authorization on an all listed patients by completing quality assurance worksheets which help identify areas for improvement and positive reinforcement.
In the absence of the Team Leader, performs the leadership functions required to maintain departmental coverage and operations within established policies and guidelines. Informs Team Leader of special occurrences and/or staff issues in a timely manner.
Assists in the orientation and technical training of new employees or employees new to a position/area (checklists are completed). Continuing education is provided by developing and delivering two staff in-services per year. Serves as Team Leader support to staff on a daily basis by assisting staff when questions arise and addressing staff concerns as they occur.
Demonstrates safe work practices, uses proper body mechanics when lifting, reaching, pushing or moving objects. Identifies, corrects and/or reports unsafe work conditions immediately. Follows Hospital protocol in the event of a work-related injury to self or staff member. Is familiar with Department fire and disaster protocol. Attends Hospital safety fair.
Maintains current knowledge and application of all Hospital legal requirements as they pertain to the Transplant Finance Department, insurance guidelines and regulations, and Department policy changes. Incorporates Sharp Mission, Values, and Philosophy in daily work practices. Insurance manuals are kept current.
Maintains current knowledge of Medicare and Medicaid rules or any legislation affecting the transplant patients. Continually network with other Transplant Financial Access Specialist, Transplant Financial Coordinators, organizations, and centers to expand knowledge and understanding of the transplant process.
Accepts coaching and counseling in a positive, productive manner. Identifies own need for skills training and practice opportunities. Accepts interpersonal differences and cooperates with other employees. Accepts responsibility for own actions, personal growth, and development.