Financial Case Coordinator-Transplant

As a member of the transplant team, the Transplant Financial Case Coordinator manages and/or coordinates all financial issues with patients, insurers, referring and attending physicians, nurse coordinators, social workers and other stakeholders.

• Perform insurance verification and analysis.
• Obtain certification and/or authorization of admission or service and furnish necessary information to utilization review for concurrent review
• Identify potential coverage issues and work with:  Specific Fairview program (UMP, HHC, IV, Rx), Patient, Admitting physician, Referring physician, Insurance company, and Employer
• Research to find other programs for payment and/or negotiate with third party payers to provide coverage by submitting medical data, citing precedents set by other payers and providing cost benefit information
• Maintain current knowledge of payer requirements and general admitting practices including use of on-line verification applications and initial and ongoing training.
• Provide financial counseling and support for patients as needed during the course of their treatment. Assist in resolving problems with payers and provide information and expertise to other departments.
• Demonstrate ability to provide care or service adjusting approaches to reflect developmental level and cultural differences of population served
• Demonstrate ability to counsel patients with billing inquiries.  Provide itemizations to patients and/or social workers as requested.  Direct patients to the correct billing entity, as appropriate Ø Coordinate with other billing entities to provide financial answers to patient inquiries
• Secure services associated with potential transplant patients
• Secure services for non-transplant patients
• Determine need for a financial exception
• Coordinate with physician and/or nurse coordinator to determine the sponsorship and outline of financial exception
• Work with UMP to draft FE and obtain signatures
• Coordinate with billing office to apply FE standards to billing
• Work with potential international and self-pay patients.  Create customized estimates based on medical services provided.  Work with patients/families/embassies to collect deposits.  Work with the billers to understand the distribution of funds.  Work with patients/families/embassies to collect additional funds as needed.  Provide documentation needed to patient/family/embassy (itemizations, bills, etc.).  Request deposit refund be submitted to patient/family/embassy if funds are remaining after patient is discharged from care
• Coordinate with all providers of service.  Confirm enrollment with atypical insurance providers.  Negotiate rates for reimbursement for financial exceptions.  Confirm acceptance of insurance rates.  Including but not limited to UMP, HHC, IV, Rx
• Kidney Paired Donation (KPD).  Secure coverage for recipient at UMMC. Coordinate with other facility or facilities involved in the KPD to ensure that their recipient has insurance for our donor.  Coordinate with other facility or facilities involved in the KPD to ensure that the other facility accepts the insurance of our
• recipient for their donor.  Counsel patient(s) involved as necessary, including Medicare
• education
• Retroactively secure insurance coverage for patients transplant prior to securing financial resources
• Assist patients with navigating insurance options.  
• Research supporting clinical and non-clinical documentation in an attempt to gather as much information as possible to secure coverage for transplantation (including but not limited to research journals, articles,
• etc.)

REQUIRED:

• BA/BS degree in business, communications or liberal arts fields or equivalent combination of education and experience
• BA/BS degree plus 2-3 years of experience (or equivalent combination of education and experience) in healthcare or insurance organizations related to admitting, billing, claims processing, financial counseling, collections, contracting.
• Strong knowledge of computer systems. Knowledge of EPIC System and Transplant Services experience preferred.

PREFERRED:

• Knowledge of PASS System; knowledge of transplant services.

Salary : $0