Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

All the benefits and perks you need for you and your family:

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance

• Paid Time Off from Day One

• 403-B Retirement Plan

• 4 Weeks 100% Paid Parental Leave

• Career Development

• Whole Person Well-being Resources

• Mental Health Resources and Support

• Pet Benefits

Schedule:

Shift:

Address:

City:

State:

Postal Code:

Job Description:

SHIFT: MONDAY - FRIDAY 8:00 AM - 4:30 pm - THIS POSITION ISX ON SITE

• Verifying insurance eligibility and transplant benefits for new and existing patients.

• Obtaining prior authorizations and payer approvals for transplant evaluations, listing, surgery, and post-transplant services.

• Reviewing payer-specific requirements and ensuring all necessary clinical documentation is submitted to support authorization requests.

• Coordinating with multidisciplinary transplant team members to prevent financial barriers that could delay patient care.

• Counseling patients and families regarding insurance coverage, anticipated out-of-pocket costs, financial assistance programs, and available resources.

• Monitoring authorization expirations and securing timely renewals to maintain uninterrupted coverage.

• Communicating with commercial insurers, Medicare, Medicaid, managed care organizations, and transplant networks to resolve coverage issues and appeals.

• Maintaining accurate documentation in the electronic medical record and financial systems to ensure regulatory compliance and continuity of care.

• Collaborating with billing, revenue cycle, and contracting teams to address claim denials, reimbursement issues, and payer requirements.

• Staying current on transplant regulations, insurance policies, CMS requirements, and payer-specific guidelines that affect transplant services.

• Supporting patients throughout the transplant continuum, from referral and evaluation through transplant, post-transplant follow-up, and long-term financial coordination.

• Serving as a patient advocate by identifying and addressing financial barriers that may impact access to life-saving transplant care while promoting a positive patient experience.

Day to-day workflow and operations for pre-transplant, transplant, and post-transplant phases. Recommends procedures for obtaining authorization, forms, and letters required for transplant processes. Provides customer service recovery when patient complaints or concerns are reported. Serves as a liaison between Managed Care and other departments. Performs crisis intervention when financial issues arise pre and post-implant/transplant. Participates in patient advocacy, resource brokering, and information and referral services. Serves as a general advocate for patients and their families throughout the pre-and post-transplant process. Participates in authorized alternatives for the program such as Letters of Agreement, Pre-Provision of Services, and Foundation Philanthropy. Works with Managed Care, Legal Services, and The Foundation to ensure proper protocols are followed if a denial is received. Prepares quotes for international patients and ensures timely billing and appropriate payment dispersal. Proactively initiates quality improvement ideas to enhance patient experience, health outcomes, and reduce clinic care costs. Establishes and maintains working relationships with key contacts at insurance companies and other departments. Maintains current knowledge of Medicare and Medicaid rules or any legislation affecting transplant patients. Other duties as assigned. Reviews all hospital and professional charges to ensure the appropriate payer, guarantor, and alternate payers are correct for proper and timely claims filing.

Knowledge, Skills, and Abilities:
• Proficiency in Microsoft (Word, Excel and Access) [Required]
• Effective oral and written communication skills [Required]
• Self-directed with ability to be part of a team [Required]
• Knowledge of medical terminology and understanding of clinical concepts [Required]
• Ability to speak confidently with physicians and leadership [Required]
• Ability to make decisions quickly [Required]
• Knowledge of insurance practices regarding benefits, authorizations and appeals [Required]
• Transplantation [Preferred]
• Ability to excel in deadline-driven, high-volume environments [Preferred]
• Knowledge and use of AdventHealth mainframe and other AdventHealth resources [Preferred]

Education:
• High School Grad or Equiv [Required]


Work Experience:
• 3+ medical office, registration, finance, collections, customer service [Required]
• 4+ consumer access/patient financial services [Required]


Physical Requirements: (Please click the link below to view work requirements)
Physical Requirements - https://tinyurl.com/23km2677

Pay Range:

Background Screening Requirement (Florida Law)

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.

Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse:
https://info.flclearinghouse.com/

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.