Springfield, IL, USA
Coordinates financial aspects of care for the transplant program. Collects accurate patient insurance information in a timely manner and advises patients on all appropriate aspects of transplant finance, including procedure costs and alternative sources of funding. Verifies insurance of all donor and transplant patients and works with health insurance providers to determine coverage and benefit limits. Processes appropriate patient bills in an accurate and timely manner. Reviews reports on a regular bases from Patient Financial Services (PFS) and Patient Access Services (PAS) to assess accuracy of registration and billing/coding processes and corrects errors through hospital registration and billing electronic information systems. Coordinates with MMC’s PFS, Springfield Clinic and SIU billing staff to ensure compliance with Medicare cost accounting practices.
1. Obtain detailed patient insurance benefit information for all phases of the transplant process.
2. Discuss benefits and other transplant financial issues with patients and/or family during initial evaluation, including but not limited to, insurance requirements and fundraising options.
3. Advise patients and/or family on insurance and billing issues and options as needed throughout all phases of transplant and donation.
4. Serve as a resource for patients and family members on financial matters.
5. Verify transplant coverage and other medical benefits and acquire necessary referrals and authorizations.
6. Monitor and update information regarding insurance data, physicians, authorizations and preferred providers.
7. Assist patients with questions concerning insurance and other financial issues.
8. Keeps current on all MMC managed care contracts related to transplant and other services, as well as federal and state guidelines related to organ transplantation and communicate changes to the transplant team, PFD and PAS as appropriate.
9. Identify and effectively communicate financial information to transplant team members, patients and their families with emphasis on identifying potential patient out-of-pocket expenses.
10. Work with patients, their families and team members when possible to help address insurance coverage gaps and to help find alternative funding options.
11. Facilitate resolution of patient billing issues.
12. Monitor both patient registration and patient billing reports on a regular basis. Coordinate with appropriate departments to correct identified registration or billing errors.
13. Coordinate billing and financial arrangements for patients as it relates to the donor acquisition fund and/or the transplant assistance fund.
14. Participate in department performance improvement activities.
15. Assume responsibility for other duties as assigned.
The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to perform tasks other than those specifically presented in this description.
• Bachelor’s Degree in Business, Communication, or a related field required.
• 1-3 years previous experience as a Financial Coordinator or with a related health care payer or clinical office preferred.
• Medical terminology, medical office, medical registration or billing experience preferred.
• Experience with Medicare conditions for coverage for specialty hospitals preferred.
• Experience with registration and billing IT applications preferred (e.g., Sapphire, Cerner).
• Demonstrates excellent interpersonal and communication skills to ensure positive relationships with all customers.
• Must be able to plan, coordinate and control all responsibilities inherent to position.
• Must be professional, able to work independently and self-motivated.
• Computer application experience with Microsoft Word and Excel required.
• Prior public contact and/or customer service preferred.
• Working knowledge of Medicare and Medicaid required; and knowledge of CMS guidelines for transplant centers preferred.