JOB SUMMARY

The Transplant Financial Review Coordinator 1 verifies transplant coverage and other medical benefits and acquires necessary referrals and authorizations. Submits medical records to insurance companies to obtain prior authorizations for all transplant service lines. Monitors transplant patients to update insurance documentation, attending physicians, authorizations, and providers. Close communication is required throughout the process with patients, insurance companies and physicians.

ESSENTIAL FUNCTIONS OF THE ROLE

• Obtains and submits medical records, provided by the Transplant clinical team, to the patient's insurance company, as requested.
• Follows up, as appropriate, with insurance companies to help with timely review of patient cases. Initiates the request for contracts, letter of agreements, and single case agreements when necessary.
• Participates in patient orientation classes to provide education on the transplant financial review process. Topics such as patient financial obligations, non-covered services related to transplant, financial policies, and alternative financial resources to assist patients who do not meet the financial guidelines are covered.
• Works within Electronic Medical Record to complete new transplant patient referrals for evaluation clearance, patient transplant listings, and reauthorizations within designated work queues.
• Calculates if patient's transplant coverage meets the Transplant program financial requirements policy. Accountable for obtaining transplant evaluation and transplant listing authorizations for high volume of patients. Once authorization is obtained or determination is made that patient does not meet program financial requirements, communicates to Transplant clinical team. This function is repeated as insurance changes occur.
• Monitors transplant patients through pre-transplant, transplant, and post-transplant phases to update insurance data, attending Physicians, authorizations, and other providers, as applicable. Ensures all appropriate stakeholders are updated on patient status, financial status and/or financial hold.
• Accountable for coordinating transplant deposits for private-pay patients.
• Rotates through on-call after business hours to complete urgent inpatient evaluation or listing requests.
• Participates in weekly Transplant Selection Committee meetings. Accountable for providing financial information if requested by Committee Chair.
• Assists with annual reverification in January of each year of transplant coverage for all patients pre-transplant through one year post-transplant.
• Answers department office number to assist with patient, provider, and insurance company questions related to transplant services.
• Completes monthly financial reports.

BENEFITS

Our competitive benefits package includes the following

• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level

QUALIFICATIONS

• EDUCATION - Associate's or 2 years of work experience above the minimum qualification
• EXPERIENCE - 2 Years of Experience