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Work Shift

Day (United States of America)

Job Summary:

Coordinates patient financial services for the transplant program. Responsible for verifying insurance coverage of recipients and donors for transplant evaluation, the transplant event, and financial needs after transplant. Responsible for educating patients regarding insurance benefits and other financial issues related to transplantation. Works with patients to address insurance coverage gaps via alternative funding options. Works with government and private insurance companies for transplant patients.

Core Responsibilities and Essential Functions:

nsurance and Benefit Assessment: Assures the financial viability of all transplant referrals throughout the continuum of transplantation. Verifies insurance coverage and benefits for all transplant-related services (hospital, physician, pharmacy and ancillary). Coordinates and initiates pre-certification/pre-authorization with necessary parties. Educates patients regarding transplant insurance coverage including but not limited to inpatient, outpatient, prescription, travel, and lodging. Patient Support: Serves as a resource for patients and their family members on all financial matters. Works to find alternative funding options when necessary. Refers patients to appropriate funding resources outside of the hospital if applicable. Collaborates with local and national resources for patient financial assistance or fundraising needs. Documentation: Adheres to documentation policies and procedures. Documentation is consistent with all applicable federal and state regulations and any amendments pertaining to Medicare, Medicaid or health insurance coverage. Consistently completes documentation in a timely manner. Knowledgeable of HIPAA regulations and follows all security policies. Updates data in OTTR in a timely manner. Education and Development: Demonstrates accountability for professional growth and development. Demonstrates up-to-date knowledge of applicable federal and state regulations related to patient insurance, benefits, and coverages. Completes hospital assigned education and competencies in a timely manner. Participates in educational in-services offered by the program, cancer center and hospital, as applicable. Possesses knowledge of transplant-related coverage by government and private payers. Communication: Demonstrates appropriate and professional use of written and verbal communication skills. Provides pertinent patient information to the multidisciplinary team in a clear and timely manner. Obtains financial clearance and updates insurance status changes as needed. Assures appropriate utilization of OTTR and EMR to resolve financial issues and complete daily assignments. Performs other duties as assigned Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

• High School Diploma / GED General

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

Additional License(s) and Certification(s):

Required Minimum Experience:

Minimum 2 years Physician office/hospital scheduling/financial services to include insurance verification Required and

Required Minimum Skills:

Computer literacy, excellent organization, and communication High Knowledge of health insurance benefits managed care or reimbursement. Transplant financial experience Low

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