Transplant Financial Counselor

Baylor St. Luke’s Medical Center is an internationally recognized leader in research and clinical excellence that has given rise to breakthroughs in cardiovascular care neuroscience oncology transplantation and more. Our team’s efforts have led to the creation of many research programs and initiatives to develop advanced treatments found nowhere else in the world. In our commitment to advancing standards in an ever-evolving healthcare environment our new McNair Campus is designed around the human experience—modeled on evidence-based practices for the safety of patients visitors staff and physicians. The 27.5-acre campus represents the future of healthcare through a transformative alliance focused on leading-edge patient care research and education. Our strong alliance with Texas Heart® Institute and Baylor College of Medicine allows us to bring our patients a powerful network of care unlike any other. Our collaboration is focused on increasing access to care through a growing network of leading specialists and revolutionizing healthcare to save lives and improve the health of the communities we serve.

Responsible for coordinating and clarifying the available financial resources for patients who have been referred for Transplant and/or VAD services. The Transplant Financial Coordinator will be a designated member of the transplant team, working with patients and their families to coordinate the financial resources required for care, beginning with the transplant evaluation and continuing post-transplant to ensure continuity of care. This position will be a recognized member of the multidisciplinary team and will provide recommendations regarding the patient’s candidacy for transplantation and or implantation. Functions as a resource to patients and families on financial matters during the transplant process, assisting with questions concerning insurance and other financial matters. Adheres to departmental policies as it relates to pre transplant evaluation charges and appropriate identification of those for the Medicare Cost Report. Responsible for establishing the hospital’s financial expectation for the patient and/or guarantor and ensuring accurate information is exchanged which determines whether the account will be processed in an efficient and expedient manner for the hospital and the patient.

Essential Key Job Responsibilities

• Obtains detailed patient insurance benefit information; medical management and transplant
• Discusses benefits and other financial issues with patients and/or family members during initial evaluation.
• Advises patients on insurance and billing issues and options. Serves as a resource for patients and their family members on financial matters.
• Coordinates all necessary payer authorizations including documentation of financial information appropriately in the EMR
• Consistently monitors and updates information regarding insurance data, physicians, authorizations and managed care contracting.
• Assists patients and their families with questions concerning insurance and other financial issues.
• Identifies and effectively communicates financial information team members, patients and their families with emphasis on identifying any potential patient out-of-pocket liability.
• Works with patients, their families and team members when possible to help address insurance coverage gaps via alternative funding options.
  
• Facilitates resolution of patient billing issues
• Ensures payers are listed Accurately, pertaining to primary, secondary, and/or tertiary coverage and billing when a patient has multiple third party/governmental payers listed on an account
• Processes patient accounts and deploys established policies to resolve insurance issues with patient accounts
• Initiates pre-cert for in-house patients when required, obtaining pre-certification reference number, approved length of stay, and utilization review company contact person and telephone number
• Notifies hospital Case Managers on all in-house patients regarding insurance plan changes/COB order, out of network plans, and Medicare supplemental plans that require pre-certification
• Contacts physician’s on scheduled patients, to notify them of authorization requirements and any possible financial holds
• Analyzes reports to ensure admission dates for patient type changes are accurate in order for the account to appear on insurance verification reports
• Maintains and update reference notebooks on insurance companies, employers, pre-certification requirements, to stay current on changes within the insurance industry
• Functions as team lead when appropriate to ensure smooth operation of daily activities. This may include assisting with coverage, scheduling, providing feedback and specific QAPI projects.
• Participates in protocol development with members of the team.
• Functions as a preceptor for newly hired transplant financial coordinators as well as an educational resource in the department.
• Serves as an EPIC super user

Required Education and Experience:

• High School Diploma/GED
• Four (4) years of related experience in Transplantation
• Completion of department’s internal certification in Transplantation

Required Minimum Knowledge, Skills, Abilities and Training:

• Extended knowledge of HMO’s, PPO’s, Commercial/Governmental payers and System/Entity specific hospital contracts with Third Party payers.
• Extended knowledge of HIPPA and EMTALA.

Disclosure Summary:

The job summary and responsibilities listed above are designed to indicate the general nature of the work performed within this job. They are not designed to contain or be interpreted as a comprehensive inventory of all job responsibilities required of employees assigned to this job. Employees may be required to perform other duties as assigned.