Description

JOB SUMMARY

The Transplant Financial Review Representative verifies coverage and other medical benefits and acquires necessary referrals and authorizations for outpatient and inpatient services. Submits medical records to insurance companies to obtain prior-authorizations for all transplant service lines. Monitors transplant patients to update insurance documentation, attending physicians, authorizations, and providers. Close communication is required throughout the process with patients, insurance companies and physicians.

ESSENTIAL FUNCTIONS OF THE ROLE
ESSENTIAL FUNCTIONS

Conducts high volume of pre-certification authorizations for all transplant service lines.

Obtains required PCP referrals for all transplant services lines, as applicable.

Monitors transplant patients through pre-transplant, transplant, and post-transplant phases to update insurance data, attending Physicians, authorizations, and other providers, as applicable.

Ensures transplant patient accounts are registered in compliance with Transplant Managed Care contractual guidelines.

Assists patients with questions concerning insurance and other financial issues. Consults with patients on insurance options and plans to help them obtain optimal coverage based on their individual situation.

Works within Electronic Medical Record to clear transplant account work queues, determine correct authorization coding/billing accounts, create Transplant Guarantors/Transplant Flag when patient transitions between general services and transplant, and to record authorization of services.

Assists with annual reverification in January of each year of transplant coverage for all patients pre-transplant through one year post-transplant.

Answers department office number to assist with patient, provider, and insurance company questions related to transplant services.

BENEFITS

Our competitive benefits package includes the following
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level

QUALIFICATIONS

- EDUCATION - H.S. Diploma/GED Equivalent

- EXPERIENCE - Less than 1 Year of Experience