When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
Transplant DepartmentJob Description:
Under the general supervision of both the Executive Director of Transplant and the Director of Financial Clearance and following established procedures, is responsible for ensuring all patients in the Transplantation and Hepatobiliary Department have the financial means to cover all the services necessary for their care. This involves working directly with the patient to evaluate their coverage and if necessary, try to improve coverage. The Transplant Financial Coordinator serves as part of the multidisciplinary transplant team providing longitudinal support to our transplant patients and their families. This role also serves as a liaison between patient and hospital billing, insurance companies, pharmacies and patient assistance programs.
Essential Duties & Responsibilities: including but not limited to:
1. Performs a comprehensive in-person interview with all kidney and liver transplant candidates to evaluate the patient’s insurance coverage and provide information on financial matters related to transplantation.
2. Researches and verifies insurance for hospital, professional and pharmacy coverage, especially immunosuppressive medications. Utilizes critical thinking to ensure patients are financially able to proceed with transplant.
3. Assists finance department and managed care area by providing data about transplant program and financial activities to support insurance contacts. Implements and coordinates the reimbursement of approved transplant contracts with the Contracting Department. Acts as the departmental liaison
between Contracting and insurance companies when establishing single case rates.
4. Pre-certify coverage for all transplant procedures, confirming prescription coverage. Recertify on a yearly basis.
5. Keeps up to date on job related regulations to ensure maximum financial coverage for patients and appropriate reimbursements. Adheres to regulations regarding transplantation including but not limited to CMS, UNOS and Joint Commission.
6. 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.
7. Work closely with specialty pharmacies to ensure appropriate coverage for transplant medications and
helps patients find pharmacy assistance programs when necessary.
8. Ensures full financial clearance for all visits, medications & injections (prior authorizations, referrals) as necessary for all nephrology, hepatology, pre / post-transplant patients and surgical patients.
9. Attends multidisciplinary patient selection committees and actively participates in the approval/denial of candidates from the insurance / financial problems perspective which may preclude patients from being listed.
10. Collaborates with financial navigators and patients to ensure proper insurance selections and assists with Medicaid and disability applications as needed.
11. Meet with live liver/kidney donors, explaining billing process. Work closely with PFS to ensure donors do not receive bills.
12. Serves as a liaison with the billing and contracting departments for any patient issues, contract information and payments.
13. Responsible for billing of multidisciplinary liver clinic and nurse's visits. Oversee end of month charges are completed for all clinic visits in department.
14. Participates in Revenue Cycle Meetings and assists with tracking payments on transplant patients.
15. Ensure contract is in place for transplant candidates. Communicate with our contract manager any concerns or problems and notify him/her of any new contract which may be necessary.
16. Give cost (charge) estimates to self-pay patients with their insurance information. Meet with enhancement group to establish correct payment.
17. Actively participates and contributes to weekly department meetings.
18. Discusses patient problems resulting from collection notices, statements and other Lahey related billing and insurance issues.
19. Assists patients with free care and Medicaid application process.
20. Updates case managers for reauthorization and notifies them of transplants.
21. Approve all donor acquisition charges for appropriate processing.
22. Review and approve invoices from the New England Organ Bank for payment and for inclusion on patient’s transplant claim.
23. Meet regularly with Finance to improve business policies and procedures to ensure proper billing for the Medicare cost report.
24. Assist in establishing a payment system with outside institutions for transplant workups, ensuring that they will accept Medicare rate of reimbursement for these services.
25. Keep accurate spread sheets for all pre- and post-transplant patients.
26. Approve all outside transplant workup invoices, ensuring they are billed at the appropriate rate.
27. Completes Medicare time studies in a timely manner for inclusion on the Medicare cost report.
28. Authorize payment for all HLA typing invoices.
29. Work with Finance and Billing to establish a system to approve all pre-transplant charges for inclusion on the Medicare cost report. This entails reviewing thousands of transplant claims to ensure they are evaluation vs treatment.
30. Work with the International Office to ensure proper accounts are established for pre-payment on all transplant patients.
31. Actively work and monitor all assigned Epic work queues that support referral management, authorization and charges for the cost report.
32. Support processing of departmental invoices with appropriate accounting information.
33. Responsible for the timely and accurate submission of transplant data into CROWNWeb.
34. Obtain 2728 forms from dialysis centers for post-transplant inpatients and submit to appropriate Social Security Offices.
35. Support the financial aspects of the paired kidney exchanges by obtaining insurance information from the recipient/donor center and ensure billing is set up correctly with internal and external billing contacts.
36. Works with live donor candidates to submit their application for financial assistance with The National
Living Donor Assistance Center (NLDAC).
Organizational Requirements:
· Maintains strict adherence to the Lahey Hospital and Medical Center Confidentiality Policy.
· Incorporates Lahey Hospital and Medical Center Guiding Principles, Mission Statement, and Goals into daily
activities.
· Complies with all Lahey Hospital and Medical Center Policies.
· Complies with behavioral expectations of the department and Lahey Hospital and Medical Center.
· Maintains courteous and effective interactions with colleagues and patients.
· Demonstrates an understanding of the job description, performance expectations, and competency assessment.
· Demonstrates a commitment toward meeting and exceeding the needs of our customers and consistently adheres to
Customer Service standards.
· Participates in departmental and/or interdepartmental quality improvement activities.
· Performs all other duties as needed or directed to meet the needs of the department.
Minimum Qualifications:
Education: High School Degree required; bachelor’s degree preferred.
Licensure, Certification, Registration: NA.
Skills, Knowledge & Abilities: Requires a broad and thorough knowledge of patient accounting and healthcare Proficiency is required in the use of Microsoft Office. Must have strong organizational skills and the ability to prioritize demands. Proficiency in communicating verbally and in writing with varied internal and external groups is required.
Experience: Two years related experience in hospital billing and/or insurance environment. Preferred experience in transplant.
Pay Range:
$22.00 - $30.00The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.
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