Finance Other - Baystate Health
Category(s): Finance, Finance Other
Full Time / Part Time: Full-Time
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 and assuring transplant department billing compliance. The primary responsibility of the Transplant Financial Coordinator is to assess the patient’s insurance coverage and financial situation for transplantation and immunosuppressant drug coverage. The Transplant Financial Coordinator is also a vital member of the transplant center Selection Committee and must provide up-to-date and accurate patient financial clearance for transplantation.
This position also assists with the application process for government or other financial assistance programs if a patient is self-pay or insurance benefits do not cover transplant services. This position works with the managed care team to ensure accurate contracts are negotiated. In addition, this position works with payment systems to ensure all charges are captured accurately throughout all phases of care.
1) Reviews referred to patients' insurance to determine coverage and eligibility before scheduling.
2)Obtains insurance authorizations for pre-, peri-, and post-transplant patients.
3)Provide staff education to clinic personnel regarding insurance requirements, changes, and any other issues affecting the financial viability of the Clinic area.
4) Counsels patients undergoing evaluation as to the financial impact of transplant, reviews their financial plan, and assists the patients in obtaining additional insurance or other coverage as applicable. Describes sample immunosuppressant drug charges and provides patients with paperwork describing their out-of-pocket charges pre-, peri- and postoperatively.
5) Coordinates with the Transplant Social Worker for assistance in obtaining grants and special assistance funds and providing information to the social worker on potential compliance or other pertinent issues.
6) Maintain knowledge of eligibility requirements, benefits, and plans for a variety of government-sponsored programs.
7) Prepares for and participates in Patient Selection Committee meetings in terms of financial clearance of potential transplant candidates.
8) Assists in resolving financial problems for transplant center patients, which includes both verbal and written correspondence with insurance companies, hospitals, physician billing services, patients, and other groups
9) Develops and assures approval by forms committee of all written materials for patient financial education and financial clearance for transplant.
10) Enters all necessary data into the transplant department databases both timely and accurately.
11) Remains abreast of all Federal and State regulations regarding organ transplantation reimbursement issues.
12) Completes transplant center charge verification daily.
13)Monitors the cost report on a bi-weekly basis to ensure billing accuracy.
14) Notifies the managed care department of potential new contracts and works as a liaison between the transplant department and the managed care department to ensure that the managed care contracts are executed appropriately for each patient.
15) Regularly monitors the insurance status of all post-transplant patients and notifies patients as necessary of any potential changes, i.e., 36-month post-transplant change to Medicare coverage.
16) Acts as a contact for insurance case managers primarily, but limited to, obtaining pre-certification. Collects and submits necessary documentation and correspondence. Performs and communicates related follow-up.
17) Keeps up to date on job-related regulations to ensure maximum financial coverage for patients and appropriate reimbursements. Adheres to rules regarding transplantation, including but not limited to CMS, UNOS, and Joint Commission.
18) Completes time studies monthly and participation in the department's continuous quality improvement program.
Required Work Experience:
At least 1-year experience in a related field or similar position in a hospital or physician practice. Experience in financial counseling, insurance reimbursement, and ESRD regulations.
Skills and Competencies:
Strong customer focus/service skills, interpersonal and practical communication, accountability, collaboration, values differences, courage, able to manage change and various stressors
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At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.
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High School Diploma (Required)
Equal Employment Opportunity Employer
Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.