Financial Coordinator

2 days ago

Greenville, South Carolina, United States Prisma Health Full time
Job Summary

As a Financial Coordinator - Transplant Program, you will play a critical role in ensuring the financial well-being of patients undergoing transplant services. Your primary responsibility will be to evaluate, clarify, and determine the financial risk involved for organ donors, recipients, transplant physicians, facilities, and internal ancillary departments.

Key Responsibilities
  • Determine patients' benefits available for evaluation, pre-transplant maintenance, transplant admission, and post-transplant follow-up care.
  • Obtain inpatient and outpatient authorizations for hospital and physician services.
  • Ensure necessary communication occurs between payors and facilities for accurate billing and reimbursement of services.
  • Obtain, clarify, and document timely receipt of financial authorizations and benefits for patients requiring transplant evaluations, hospitalizations, and other transplant-related inpatient or outpatient services.
  • Ensure insurance coverage is available prior to services being rendered.
  • Determine scope of patients' benefits, including coverage for hospital, physician, outpatient, pharmacy, home health, organ procurement, rehabilitation, and DME services.
  • Receive notifications of all transplant referrals from internal and external sources and identify and document primary and secondary payors.
  • Obtain necessary authorizations for hospital and physician services to be provided in inpatient and outpatient settings.
  • Coordinate financial reviews of patients' resources with transplant social workers and make recommendations to administrators regarding additional financial resources.
  • Ensure implementation of transplant financial policy guidelines.
  • Meet with patients and families to clarify insurance benefits and scope of coverage as needed.
  • Consistently document all interactions with patients and family members.
  • Manage and direct maintenance of financial logs regarding status of patients' primary and secondary payors.
  • Update patient accounting, admitting, and physician offices regarding changes in patients' payor information.
  • Perform re-certification on all inpatients, coordinating communications between clinical coordinators, physicians, social workers, hospital utilization review coordinators, patients/families, and payors.
  • Clarify appropriate type of admission required for inpatient or invasive procedures.
  • Identify other financial resources available for patients and consult with transplant social workers for patient follow-up and feedback.
  • Review initial clinical information to determine medical appropriateness of referrals and review data with medical directors as necessary.
  • Receive patients' demographic updates and ensure information is entered into transplant database and hospital patient account in a timely manner.
  • Ensure interactions with third-party payors' case managers and contract managers occur timely, accurately, and professionally.
Additional Responsibilities
  • Initiate discussions with payors regarding individual contracts to be negotiated for patients referred for transplant evaluation.
  • Develop and maintain professional relationships with third-party payors' case managers and medical directors to complete and obtain benefits and authorizations in a timely manner.
  • Monitor and trouble-shoot third-party payor reimbursement denials to correct potential issues.
  • Monitor and identify changes in regulations and legislation regarding Medicare and third-party payor reimbursement for organ transplantation.
  • Liaise with Greenville Memorial Hospital and transplant physicians' offices regarding authorization or billing issues.
  • Participate in on-site payor visits as requested.
  • Assist in the ongoing education of transplant staff regarding updates in transplant contracts, Medicare reimbursement, and outside resources available to patients.
  • Participate in transplant patient selection committee meetings and make changes to patient status according to selection committee vote.
  • Participate in Transplant Financial Coordinators Association (TFCA) and other professional organization committees to expand and contribute knowledge of transplant reimbursement and managed care.
Requirements
  • High School diploma or equivalent.
  • Associate's degree in related field such as accounting or finance preferred.
  • 3 years related experience in healthcare patient financial services, financial counseling, healthcare patient accounting, admitting, utilization review, quality assurance, or case management required.
  • Prior experience with transplant financial counseling and/or transplant insurance authorizations preferred.
  • Medical Terminology knowledge required.
Certification and/or Licensure Requirements
  • TFCA (Transplant Financial Coordinators Association) certification within 2 years of hire date.
  • Certified Patient Accounts Representative (CPAR) and/or Certified Patient Financial Counselor (CPFC) in hospital setting preferred.
Work Shift

Day (United States of America)

Location

Greenville Memorial Med Campus

Facility

1008 Greenville Memorial Hospital

Department

Nursing Service-KTC

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