Transplant Financial Coordinator - Detroit Main Campus
- Detroit, MI
- Permanent
- Full-time
- Verify insurance coverage eligibility of patients prior to scheduling and delivery of services.
- Determine the scope of benefit coverage for services including areas such as hospitalization, professional services, pharmacy, home health, rehabilitation, DME and organ procurement limitations.
- Coordinate the activities to obtain pre-authorization for appropriate services including clinical input, patient financial commitment amounts, eligibility periods, CPT and ICD-10 information and relevant patient compliance information.
- Maintain adequate communication channels with third party payers and internal clinical departments.
- Serve as an intermediary amongst the patient and/or family members, insurance companies and clinical areas to assist in obtaining necessary insurance coverage and authorization information.
- Attend organ team selection meetings to represent financial perspective of patient eligibility for organ listing.
- Process and coordinate the resolution of assigned work queues in Epic to assist in the processing of claims.
- Serve as a resource to inform patients and their families of the Transplant Institutes financial policies and outstanding obligations related to financial clearance.
- Meet with patients and their families to discuss financial information relative to pre-transplant processes, or, if transplanted, post-transplant coverage.
- Maintain regular and timely eligibility verifications on listed patients that are becoming more likely to be transplanted.
- Perform regular reviews of eligibility for elective surgical candidates for identified non-transplant patients.
- Maintain documentation of all financial communications and “touches” on patient statuses.
- Contact referring physicians for necessary patient information to process financial determinations.
- Work in support of the Transplant Institute financial area to review outstanding claims, underpayments, and single case agreements.
- Serve as a resource relating to insurance questions from various internal HFH areas.
- Develops and maintains an adequate understanding of managed care, CMS and UNOS guidelines relative to transplantation and financial involvement,
- Represents HFH to external agencies on issues involving admissions, financial policies and procedures.
- Contact insurance company's case managers for expedited and emergent requests for transplant authorizations.
- Participates in ongoing efforts of the Transplant Institute to increase efficiencies and quality through LEAN processes.
- Regularly attends and participates in the Transplant Institute's monthly staff meetings.
- High school diploma or G.E.D. equivalent. Associates degree is preferred.
- General knowledge base of billing requirements and rules.
- Comprehensive knowledge of insurance coverage generally obtained through three (3) or more years of relevant experience, preferably in a hospital setting.
- Extensive knowledge of various insurance coverage, COB rules of priority and processing procedures.
- Basic computer skills required to operate a personal computer.
- Organizational and time management skills required in order to maintain and prioritize daily work, weekly reports and to follow-up on accounts in a timely manner.
- Ability to work in self-directed environments.
- Medical billing background, preferred.
- Understanding of Medicare and Medicaid regulations and rules with a background in coordination of benefits, preferred.
- Must have a good grasp of medical terminology.
- Works in a stressful fast paced environment.
- Extensive utilization of personal computers.
- Extensive telephone, oral and written contact with internal and external customers.
- Organization: Henry Ford Hospital - Detroit Main Campus
- Department: Transplant Admin
- Shift: Day Job
- Union Code: Not Applicable