Transplant Financial Counselor (Onsite)
Memorial Hermann Health System
Houston, TX
Description
At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.
Job Summary
The Transplant Financial Counselor functions as a technical expert regarding transplant financial reimbursement and insurance coverage. The Transplant Financial Counselor advises patients on the complexities of transplant insurance benefits, advises patients on the notification and prior authorization/referral requirements, creates estimates /prepayment requirements, and researches when government programs are available and can be used in conjunction with other payors. This role will report to Transplant leadership with a dotted line to Revenue Cycle – Financial Clearance.Job Description
Desired Skill Sets:
The ideal candidate would have experience working in Transplant financial services and approval.
Experience working in financial approval and understands transplant process
Insurance verification and revenue cycle experience is ideal
Able to work with sensitive information in a professional manner
Strong customer service experience in a patient facing environment
Ability to use compassion and empathy
MINIMUM QUALIFICATIONS
Education: High school diploma or equivalent required; Bachelor’s in Finance, Healthcare Administration or related field preferred
Licenses/Certifications: (None)
Experience / Knowledge / Skills:
- Three (3) years' experience in Health Care revenue cycle, insurance, and/or transplant required.
- Significant degree of independent judgment and decision making due to the extensive level of coordination that occurs between contracted and non-contracted payers, reinsurers, the transplant department, and patient financial services.
- Understanding of various complex transplant contracts, payer requirements, and Medicare and Medical Assistance transplant coverage regulations preferred.
- Ability to remain calm under pressure and deal effectively with difficult/urgent situations.
PRINCIPAL ACCOUNTABILITIES
- Evaluate transplant candidates for ability to pay after insurance eligibility is determined by patient financial services, including accurate financial sponsorship when applicable.
- Explain hospital payment policy to patients if full coverage is not available (uninsured or underinsured patients). Obtain an estimate for any patient liability before or at the time of services.
- Explain the fiscal requirements and financial liabilities of transplantation; ensure patients and families understand the complex financial details associated with transplant procedures.
- Determine the appropriate financial options for the transplant patient. Provide the patient with appropriate alternatives if applicable:
- Responsible for the administrative/financial clearance decision to list a patient for transplant; Participate in Medical Review Board, Transplant Multidisciplinary Rounds, and Patient Care Conferences as directed
-
Provide continued support once the patient has been accepted into the transplant program:
Finalize the administrative/financial clearance to list a patient for transplant
Prepare patient admission documents; verify patient transplant insurance benefits and discharge medication coverage.
Monitor transplant readiness and update the Medical Review Board if situation changes.
- Maintain current knowledge of all regulations and guidelines regarding transplants as well as insurance requirements.
- Take calls- as agreed upon by schedule- for transplant patient concerns which occur after normal business hours, to always ensure continuity of care.
- Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
- Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as a resource to less experienced staff.
- Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards of providing safe, caring, personalized and efficient experiences to patients and our workforce.
- Other duties as assigned.