POSITION SUMMARY:

This position is responsible for collecting financial and insurance information from pre-transplant patients, verifying coverage, and obtaining required pre-certifications. Communicates with insurance case managers. Counsels patients on financial issues surrounding the transplant. Conducts initial review of patient bills for inclusion in Kidney Acquisition Cost Center. Works closely with Transplant Social Worker. Communicates patient financial status with transplant team and others involved in the transplant process. Participates in providing patient specific care standards as directed and follows service excellence standards to ensure high levels of patient satisfaction.

ESSENTIAL JOB RESPONSIBILITIES:

• Obtains appropriate information on patient’s healthcare coverage.
• Obtains relevant insurance from patient.
• Verifies patient and living donor benefits with patient’s insurance.
• Determines if pre-certification is required for evaluation, transplant admission and/or follow-up care.
• Obtains required pre-certification from insurance company.
• Communicates with insurance case manager regarding the pre-certification process.
• Sends required patient information to case management.
• Informs case manager of listing by committee as necessary.
• Maintains appropriate communication with case management throughout the transplant process.
• Obtains necessary pre-certifications for post-transplant care.
• At the time of admission, informs business office and other involved providers of patient insurance coverage and pre-certification information.
• Communicates financial concerns to other individuals involved with the patient.
• Keeps transplant team informed of patient’s financial situation and status within the process.
• Communicates with physician offices and hospital regarding the billing process for living donors.
• Informs Partnership managed care department of new managed care patients that may require special contracting prior to evaluation and/or transplantation.
• Seeks assistance for complex cases from Transplant Social Worker or Department Director.
• Reviews patient bills for inclusion in Kidney Acquisition Cost center.
• Conducts initial review for suitability in KACC.
• Enters charges in financial database.
• Prepares monthly report for Director and Accounting.
• Conducts financial counseling with patients.
• Meets with each pre-transplant patient to complete individualized financial plan.
• Counsels patients on financial issues and advises them on planning for the transplant.
• Refers pre- and post-transplant patients to social worker as needed for financial assistance and referral.
• Contract Management
• Ensures contracts are in place with providers prior to appointment being scheduled and bill getting paid.
• Enter basic contract discussion with providers. Refer difficult negotiations to Department Director.
• Enter contracts into log for contract management purposes.
• Employee’s conduct must reflect the Company’s values and a commitment to the Code of Conduct ethics and compliance program.
• Employee reflects SDH Service Excellence standards in every interaction.
• Other duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:

Must be able to demonstrate understanding of HCA’s and North Austin Medical Center’s safety protocols and procedures, HIPAA and HITECH.

EDUCATION AND EXPERIENCE:

Required: High school diploma or equivalent; strong interpersonal and organizational skills required; intermediate computer skills including Excel, Word, Outlook and various insurance verification databases.

Preferred: Experience with patient registration, financial counseling or medical insurance