Financial Coordinator - Transplant Program, Solid Organ Transplant Clinic, FT, Days

Job description

Inspire health. Serve with compassion. Be the difference. Job Summary Accountable for evaluating, clarifying, and determining the financial risk involved for organ donors, recipients, the transplant physicians, the facility and any possible internal ancillary departments, and patients as transplant services are required. This includes determining the patient’s benefits available for evaluation, pre-transplant maintenance, Transplant admission, and post-transplant follow-up care; obtaining inpatient and outpatient authorizations for hospital and physician services; and ensuring necessary communication occur between the payor, and the facility for appropriate and accurate billing and reimbursement of services. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Obtains, clarifies, and documents the timely receipt of financial authorizations and benefits of patients requiring transplant evaluations, hospitalizations, and other transplant related inpatient or outpatient services. Ensures that insurance coverage is available prior to services being rendered. Determines scope of patients’ benefits including but not limited to coverage for hospital, physician, outpatient, pharmacy, home health, organ procurement, rehabilitation, and DME services. Receives notifications of all transplant referrals from both internal and external sources. Identifies and documents primary and secondary payors. Obtains necessary authorizations for hospital and physician services to be provided either in the inpatient and outpatient setting. Transmits the verification numbers and billing information to the hospital finance department, the central billing office (if applicable) and the various physician offices. Coordinates the performance of a financial review of the patient’s resources with the Transplant Social Worker. Makes recommendation to the Administrator regarding any additional financial resources that may be available for the patient. Ensures the Transplant Financial Policy guidelines are implemented. Meets with and/or performs telephone consultations with patients and their families regarding insurance benefits and clarifies scope of insurance coverage as needed. Consistently document all interactions with patients and family members. Manages and directs maintenance of financial logs regarding status of patient’s primary and secondary payors. Updates patient accounting, admitting, and physician offices regarding any changes in the patients’ payor’s class is entered and updated as needed. Performs re-certification on all inpatients, coordinating communications between the clinical coordinators, physicians, social workers, the hospital utilization review coordinators, the patient/family, and the payor. Clarifies the appropriate type of admission required for inpatient or invasive coordinate scheduling appointments. Identifies other financial resources that may be available for patients. Consultants with Transplant Social Worker for patient follow-up and feedback. Reviews initial clinical information to determine medical appropriateness of referral. Reviews data with medical directors as necessary prior to proceeding with authorization process. Receives patients' demographic updates and ensures information is entered into transplant database and hospital patient account in a timely manner. Ensures interactions with third party payors case manager and contract managers occur timely, accurately, and professionally. Initiates discussions with payor regarding any need for and individual contract to be negotiated as patients are referred for transplant evaluation. Notifies transplant managed care specialist who will negotiate with payors as necessary. Consistently documents all interactions with payors. Performs written correspondence to payors to obtain and to send information and letters of medical necessity. Develops and maintains professional relationships with third party payors’ case managers and medical directors in order to complete and to obtain benefits and authorizations in a timely manner. Monitors and trouble-shoots any third-party payor reimbursement denials to correct potential Transplant Administrator and Medical Directors in a timely manner. Monitors and identifies changes in regulations and legislation with regard to Medicare of third-party payor reimbursement for organ transplantation and updates Transplant Administrator and Directors in a timely manner. Liaison for Greenville Memorial Hospital and transplant physicians’ offices to the payors regarding authorization or billing issues. Participates in on-site payor visits as requested. Assist in the ongoing education of transplant staff regarding updates in transplant contracts, Medicare reimbursement, and outside resources available to patients. Assist in the development and revision of departmental guidelines such as the Transplant Financial Policy. P resents in-services to transplant staff, hospital staff, and physician office staff regarding managed care updates and assists in development and implementation of communications systems to send and to receive clinical and financial data between payors and patients referring physicians, transplant physicians, and payors. Participates in transplant patient selection committee meetings and makes changes to patient status according to selection committee vote (i.e. List for transplant, hold, inactivate, etc. Participates as a member of Transplant Financial Coordinators Association (TFCA) and other professional organization committees to expand and to contribute knowledge of transplant reimbursement and managed care. Participates in necessary professional organization, meeting, etc. to remain current of financial and reimbursement issues that may impact transplant care. Performs other duties as assigned. Supervisory/Management Responsibilities This is a non-management job that will report to a supervisor, manager, director or executive. Minimum Requirements Education - High School diploma or equivalent. Associate degree in related field of study preferred. Experience - Three (3) years related experience (i.e., healthcare patient financial services, financial counseling, healthcare patient accounting, admitting, utilization review, quality assurance or case management). In Lieu Of In lieu of minimum requirements stated above, may accept Bachelors in Accounting/ Finance and one (1) year of related experience (i.e.., patient financial services, healthcare patient accounting, admitting, utilization review, quality assurance or case management). Required Certifications, Registrations, Licenses TFCA (Transplant Financial Coordinators Association) certification within 2 years of hire date Certified Patient Accounts Representative (CPAR) and/or Certified Patient Financial Counselor (CPFC) in hospital setting preferred. ​ Knowledge, Skills and Abilities Medical Terminology knowledge Experience with transplant financial counseling and/or transplant insurance authorizations preferred. Work Shift Day (United States of America) Location Greenville Memorial Hospital Facility Greenville Memorial Hospital Department Solid Organ Transplant Clinic Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.