Transplant Financial Coordinator-Medicare Cost Report Specialist

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy thats served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. Its our passion.

Disclaimer

The following job description is designed to indicate the general nature and level of work performed by

employees within this classification. It is not designed to contain or be interpreted as a comprehensive

inventory of all duties and responsibilities required of employees assigned to this job.

Shift: Day shift 7:30-4:00 PM. Monday - Friday Potential Hybrid position when on campus RJA Building.

Primary Purpose

The Transplant Financial Coordinator plays an integral role in assisting transplant patients with the critical function of financial planning for their transplant surgery and future medical needs as well as assuring transplant department billing compliance. The primary responsibility of the Transplant Financial

Coordinator is to assess patients insurance coverage and financial situation for transplantation and

immunosuppressant drug coverage. The Transplant Financial Coordinator is also a key member of the

transplant center Selection Committee and must provide up to date and accurate input on patient

financial clearance for transplantation. The Transplant Financial Coordinator is also responsible for

ensuring that patients maintain ongoing financial coverage.

Additional information the hiring manager is seeking in their top candidate:

Qualifications

Minimum 2 years medical insurance benefit coverage assessment, processing & invoices; including HMO and PPO experience

Prior authorization experience

Bilingual preferred (Spanish)

The Transplant Financial Coordinator-Medicare Cost Report Specialist will utilize EPIC reviewing patient charts to verify if there is kidney verbiage.

Responsibilities

• The Transplant Financial Coordinator TFC is responsible for analyzing and validating the information needed to obtain financial approval for transplant
• The TFC will mitigate the financial risk by performing an accurate financial review along with a comprehensive analysis of patient payer specific benefits and patient liability
• Review benefit requirements and start the request for authorization approval for the transplant evaluation, admission, clinic visits, work-up and testing, organ procurement, and post-transplant services
• Review benefit requirements and start authorization, pre-certifications and /or pre-determinations for treatments
• Review benefits for appropriate coverage for services
• Review contracts and obtain clarification from contracting as needed
• Meet with patients and family members at the time of transplant evaluation; explain to the patients the anticipated costs of transplant services and patient responsibilities (i.e post-transplant meds); help patients and families create a financial plan when benefits are not sufficient to cover transplant costs
• Coordinate with Intermountain Contracting Services to create single case agreements for self-funded or international patients
• A Coordinate with Intermountain transplant clinical teams, social workers, etc, the patients financial situation, expected coverage and out of pocket expenses, additional funding sources as well as any potential concerns
• Additional duties as assigned by management
• Review and resolve any issues related to the patient as insurance coverage
• Help coordinate referrals to external transplant programs when the patient as insurance is out of network
• Follows transplant policies and procedures as they relate to obtaining the financial approval
• Coordinates these policies and procedures and works closely with the transplant billing team to ensure compliance
• Provide continuous financial counseling based on the patient as benefits and calculate the estimated post insurance expenses for the patient
• Interact with transplant clinical staff and patients to obtain patient demographics to begin the insurance verification process

Education

Must have a High School diploma or GED.

Experience

Must have three years of relevant experience.

Experience in financial counseling, insurance reimbursement and ESRD regulations.

Prior transplant experience preferable.

Basic knowledge of insurance regulations, medical terminology, and basic computer skills.

Equivalent Education and/or Experience

May have an equivalent experience to substitute for the education requirements.

Skills or Special Abilities

Candidate must be able to deal effectively with the public and have excellent customer service skills.

Candidate must have a strong understanding and knowledge of all types of health insurance and

benefits.

Candidate must be familiar with ESRD regulations.

Candidate should have critical thinking skills to make assessments based on information provided by the patient.

The candidate must be highly computer proficient including Microsoft Word, Microsoft Outlook, and

Microsoft Excel skills.

Candidate must be able to communicate effectively, have excellent language skills, and the ability to

formulate comprehensive system account notes and correspondence.

Candidate must be able to multi-task and prioritize work appropriately.

Candidate must be able to work well with a multidisciplinary transplant team.

Candidate must demonstrate knowledge and skill in meeting age related and handicapped patient's

needs.

Candidate must demonstrate patient centered/patient valued behaviors.

Responsibilities

1. Interviews patients and families to obtain detailed patient insurance benefit information for all aspects of the transplant process, including but not limited to outpatient prescription drugs, organ acquisition,

follow-up clinic visits, travel and housing. Coordinates resources, insurance coverages, payorauthorizations/certifications to ensure that Parklands financial viability is secured at the most basic level.

2. Discuss benefits and other transplant financial issues with patients and/or family member during initial evaluation. Serves as a resource for patients and family members on financial matters providing

financial counseling and application assistance to all potential transplant candidates and all

established transplant patients to ensure patients are aware of all the choices and options available to

them. Identifies and communicates financial information to transplant team members, patients and

their families with emphasis on identifying any potential patient out-of-pocket liability.

3. Facilitates resolution of patient billing issues, investigates complaints and reports findings to

Transplant Manager. Takes action towards complaints as directed.

4. Maintains data base information on transplant candidates to include transplant stage, pre-certification status and financial status. Gathers data and completes statistical reports as required by regulatory agencies.

5. Serves as the department liaison with managed care organizations. Gathers and provides clinical

information required by the Managed Care Office (MCO). Monitors and maintains data base for

managed care contracts. Evaluates new managed care companies as potential partners, recommends

appropriate changes to contracts to improve effectiveness, productivity, and efficiency. Monitors

contract status and negotiations issues. Conducts the monthly status meeting and participates in the

Managed Care Implementation Committee educating directors and managers on current managed

care issues. Prepares reports for administrators as requested.

6. Maintains a positive working relationship with contacts at all agencies and funding programs, patients, insurance companies, government entities, clinical personnel and management to promote teamwork, cooperation, and a positive public image for Parkland. Identifies and supports the goals of the transplant service and Parkland while serving as a positive role model to staff and patients.

7. Provides training and updated information to Transplant Team members and Director of Nursing.

Assesses staff capabilities ensuring maximum utilization of individual while providing optimal service.

Serves on various committee and task forces as assigned.

Job Accountabilities

1. Identifies ways to improve work processes and improve customer satisfaction. Makes

recommendations to supervisor, implements, and monitors results as appropriate in support of the

overall goals of the department and Parkland.

2. Stays abreast of the latest developments, advancements, and trends in the field by attending

seminars/workshops, reading professional journals, actively participating in professional

organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.

3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the

area. Develops effective internal controls designed to promote adherence with applicable laws,

accreditation agency requirements, and federal, state, and private health plans. Seeks advice and

guidance as needed to ensure proper understanding.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.As part of our commitment to our patients and employees wellness, Parkland Health is a tobacco and smoke-free campus.