Finance Mgr

Patient Services Coordinator

Responsible for evaluating benefit coverage and financial liability. Works with patients and family members to ensure understanding of benefit coverage and areas of personal liability. Coordinates with other transplant team members regarding resolution of financial issues; facilitating patient through the referral process to evaluation and listing in a timely manner. Responsible for scheduling patient evaluations.

Organizes and maintains schedule for evaluations, waitlist and post-transplant clinic visits.

Obtains, reviews and updates patient insurance benefit information to determine eligibility, network requirements, transplant benefits, deductibles, out-of-pocket, coinsurance, lifetime max, pharmacy benefits (co-payment for retail / mail order). Evaluates information in the context of program participation with identification and resolution of financial barriers.

Provides patient education during initial consultation regarding benefit coverage, gaps, and limitations, assisting transplant social worker with community resources and special funding solutions to supplement insurance / benefit needs.

Acquires authorization for insurance companies for transplant services as necessary. Requests, receives and organizes medical records from primary care and specialists for evaluation of patient listing committee.

Serves as a resource for patients, family members and patient representatives regarding transplant insurance and billing issues. Answers questions and assists patients with resolution for financial issues with insurance companies and hospital / clinic bills. Monitors, updates and identifies changes in insurance coverage / benefits throughout their time in the transplant program.

Processes billing statements from providers, identifying pre-transplant cost for Medicare and commercial cost reports. Produces and maintains documentation and worksheets regarding transplant cost and billing processes / reports. Serves as the primary liaison to hospital financial analysts regarding CMS cost reports, quarterly reports for payment collection and accuracy. Identifying and maximizing payment opportunities for transplant center services in collaboration with financial analysts, team members and surgeons.

Maintains knowledge of federal End Stage Renal Disease (ESRD) guidelines, commercial and Medicare transplant specific financial and benefit requirements as well as Medicare Cost Reporting requirements. Maintains knowledge of available patient funding sources for all phases of transplant services.

Education : Two year business degree required and one year of medical office coding or billing experience.

Experience : Prior medical billing and ICD10 and CPT coding experience required. Working knowledge of medical insurance, accounts receivable and collections.

License(s) / Certification(s) : Coding Certification preferred.

Knowledge / Skills / Abilities : Writes, reads, comprehends and speaks fluent English. Multicultural sensitivity. Microsoft Office - basic computer skills. Customer / patient focused. Critical thinking skills using independent judgment in making decisions. Must be able to multitask and stay on track with completing job functions in a very busy work environment with multiple distractions. Ability to adapt to frequent changes in insurance plans, hospital and departmental procedures, job functions and new technology.