Transplant Financial Coordinator Jobs

About The Position

Requirements

• High school diploma or equivalent.
• Five years of experience in medical billing (hospital and/or professional), processing financial transactions, and/or a finance-related field.
• Working knowledge of third-party payer verification terminology and payer and utilization review agency operations.
• Working knowledge of State and Federal programs, including Medicare, Medi-Cal, CCS programs, out-of-state Medicaid, and other sponsoring agencies.
• Working knowledge of health plans with special processing requirements for emergency patients and ability to communicate those requirements to physicians and administrative personnel under time-urgent conditions.
• Working knowledge of HMOs and PPOs.
• Ability to manage many details within a short span of time.
• Skill in analyzing information, problems, situations, practices, or procedures; identifying relevant factors and patterns; drawing logical conclusions; and recognizing alternatives and their implications.
• Thorough knowledge of medical terminology and coding.
• Working knowledge of healthcare and insurance authorization processes.
• Excellent telephone etiquette and ability to work with a diverse interdisciplinary team.
• Proficiency with Microsoft Office, including PowerPoint, Excel, and Outlook.
• Ability to be at the workstation and ready to work from the scheduled start time through the end of the shift, except for designated breaks.

Nice To Haves

• Associate degree.
• Transplant financial counseling and billing experience.
• Advanced knowledge of medical billing, reimbursement, and collections processes.
• Advanced knowledge of healthcare and transplant terminology.
• Knowledge of transplant billing requirements.

Responsibilities

• Provide comprehensive, ongoing financial counseling to transplant candidates, potential living donors, and their families.
• Explain insurance coverage, treatment costs, hospital billing policies, payer benefits, billing issues, alternative funding options, and personal financial responsibilities.
• Ensure adequate insurance benefits or funding arrangements are in place before transplantation.
• Document interactions with patients and family members and confirm, obtain, verify, and update post-transplant insurance, financial, statistical, and demographic information.
• Assist patients with fundraising, Medicare, Medicaid, disability applications, indigent funding, and other ways to meet transplant expenses.
• Provide post-transplant billing counseling, including discussion of benefits and financial concerns.
• Obtain and document patient insurance benefit information for all phases of transplantation, including prescription drugs, organ acquisition, clinic visits, and travel or lodging when necessary.
• Obtain payer authorizations, verify transplant coverage and other medical benefits, and secure referrals and precertifications when required.
• Gather clinical documentation and other information payers require for approvals at different transplantation phases.
• Communicate the status of payer requests, denials, potential denials, and non-covered services to appropriate clinical staff; coordinate appeals and follow up on prior authorizations.
• Verify the accuracy and completeness of financial, insurance, and demographic information for transplant outpatient encounters and inpatient admissions.
• Complete inpatient admission notifications and coordinate with Utilization Management to meet insurance carrier requirements for admission and discharge information.
• Maintain working relationships with insurance company contacts, including case managers and medical directors.
• Collaborate with clinical staff on pre-authorizations, denials, medical reviews, appeals, managed care contracts, and referrals to support timely financial clearance and avoid high-dollar denials.
• Complete Medicare Form 2728 for eligible post-transplant patients and assist with Medicare enrollment applications.
• Work with the Team Leader to ensure complete and accurate insurance information and current transplant authorizations for listed patients; complete quality assurance worksheets.
• Prepare for and attend transplant selection committee meetings and present and discuss patients’ financial issues.
• In the Team Leader’s absence, perform leadership functions needed to maintain departmental coverage and operations within established policies and guidelines.
• Inform the Team Leader promptly of special occurrences or staff issues.
• Assist with the orientation and technical training of new employees or employees new to a position or area, and complete training checklists.
• Develop and deliver two staff in-services per year and support staff by answering questions and addressing concerns.
• Assist in other transplant finance areas to address temporary workflow backlogs and adapt positively to assignments, workload changes, and schedule changes.
• Maintain current knowledge of hospital legal requirements, insurance guidelines and regulations, department policy changes, Medicare and Medicaid rules, and legislation affecting transplant patients.
• Follow safe work practices, report unsafe conditions, follow injury and emergency protocols, and attend the Hospital safety fair.
• Incorporate Sharp’s mission, values, and philosophy into daily work and maintain current insurance manuals.
• Continue professional development, accept coaching, identify training needs, cooperate with colleagues, and take responsibility for personal growth and actions.
• Complete other duties assigned by direct management.