Transplant and Renal Services Financial Specialist

5 days ago


Buffalo, New York, United States Erie County, NY Full time
Job Summary

We are seeking a highly skilled Financial Clearance Specialist to join our team at Erie County Medical Center. As a key member of our Transplant and Renal Services team, you will be responsible for providing accurate and professional financial clearance to patients seeking transplant and renal services.

Key Responsibilities
  • Process new referrals for evaluation, insurance verification, and clinical coordination of treatment plans
  • Evaluate patient files for completeness and accuracy
  • Interview patients to obtain required demographic, insurance, and financial information
  • Provide financial clearance by analyzing, organizing, and utilizing complex data and rules related to contracting and patient benefits
  • Obtain authorizations and pre-certifications
  • Coordinate with multi-disciplinary teams to develop agreements for international, self-pay patients, and patients with limited benefits
  • Prepare financial packets based on individual patient's benefits, financial review, and calculated estimated expenses
  • Notify patients if not financially approved for evaluation
  • Provide financial counseling and inform patients of anticipated costs of all phases of transplant services, liabilities, and responsibilities
  • Maintain and update electronic medical records (EMR), transplant databases, and transplant-specific billing information
  • Review patient visits to determine if visit was transplant-related and identify correct account for accurate billing
  • Review hospital billings for appropriate recording of charges
  • Review denials for evaluation and/or transplant and initiate the appeal process with the insurance payer
  • Assist patients with a financial plan, including explaining billing, arranging payments, and evaluating requests for financial assistance
  • Make financial referrals if required
  • Perform ongoing financial review and analysis of patient's eligibility, benefit changes, and financial status
  • Compile and prepare statistical data for reports
  • Attend meetings, participate in committees, and quality improvement initiatives
  • Act as a receptionist and provide routine information
  • Compose routine letters and correspondences
  • Verify all regulatory requirements are met in patient records
  • Obtain and verify authorization for evaluation, transplantation, admission, procedures, and medications
Requirements
  • Graduation from high school or possession of a high school equivalency diploma
  • Three years of healthcare experience, one year of which included insurance verifications, procedure authorization, or billing experience
Preferred Qualifications
  • Medical examination may be required before appointment
  • Veterans: proof of service must be submitted before list is established to receive additional points


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