Where compassion meets innovation and technology and our employees are family.

GENERAL PURPOSE OF JOB:

To ensure the effective financial reimbursement of DCH transplant/dialysis program and dispense quality service to patient/family by providing comprehensive and ongoing financial counseling. This position interacts with various levels of hospital and transplant services physicians, clinical coordinator, managed care staff, social work, patient account services, outside consumers/providers and other related personnel, via telephone and in person to accomplish the
responsibilities of the position.
 

ESSENTIAL DUTIES AND RESPONSIBILITIES:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the
immediate supervisor and/or hospital administration as required.

• • Responsible for Transplant minutes.
• • Responsible for the workup scheduling.
• • Serves as a financial resource to self-pay transplant candidates; discusses financial alternatives; explores funding arrangements. Research, coordinates and shares information about self-pay funding options and programs, prescription drug coverage, transplant-related discharge medications, and spend down insurance plans with transplant social workers and other team members, as needed.
• • Keeps current on all DCH managed care contracts related to transplant and other services, as well as federal and state guidelines related to organ transplantation.
• • Maintain communication between medical staff, and department heads by attending meetings and coordinating interdepartmental functioning.
• Participates in transplant candidate and live donor orientation sessions and acts as a resource to the transplant candidate, family and live donor on billing problems.
  • Research and verification of insurance coverage and limitations (including determination of available insurance coverage for unrelated services, financial screening and counseling.
  • Coordination of resources when inadequate or no insurance is available’ this includes the performance of financial asset analysis.
  • Presentation of financial profile and evaluation meetings.
  • Other pertinent meetings with hospital administration.
  • Providing a requirement list to approved candidates of expected deposits, insurance pre-authorization/certification, and any financial documentation.
  • Enter Dialysis Charges to include Inpatient, Outpatient and TPE
  • Determine insurance coverage for immunosuppressive medications and other transplant related discharge medications. Arrange pharmacy charge accounts for each patient with insurance coverage for medications.
  • Provide financial counseling on choices of insurance coverage, including COBRA, Social Security Disability, Texas Medicaid, and new employee coverage to all potential transplant candidates and all established transplant patients.
  • Responsible for placing the standard acquisition charge on the patient account.
  • Initiate pre-certification of inpatient and outpatient services for all transplant patients, both pre and post-transplant.
  • Collects and reports financial data essential for financial management of Transplant and Dialysis program and participates as a team member in interpretation of data and financial management of the programs
  • Write or obtain from the physician a “letter of medical necessity” and associated documents, which are sent to the provider and follow-up on the response by providing necessary documentation of coverage and communication of status to the clinical coordinator responsible for the care.
  • Educates transplant candidates regarding the Medicare and Medicaid application process (es) and program coverage; provides information, as appropriate.
  • Assists with applications, eligibility guidelines and billing issues. Keeps apprised of changes in federal and state guidelines related to organ transplantation and communicates changes to
  Director/Manager , Transplant Team and applicable DCH departments.
  • Together with DCH Contracting Department, compares insurance benefits with DCH’s transplant-specific contracts in order to secure approval of the transplant evaluation.
  • Keeps current on all DCH managed care contracts related to transplant and other services, as well as federal and state guidelines related to organ transplantation.
  • Participates in transplant candidate and live donor orientation sessions and acts as a resource to the transplant candidate, family and live donor on billing problems.
  • Serves as a financial resource to self-pay transplant candidates; discusses financial alternatives; explores funding arrangements. Researches, coordinates and shares information about self-pay funding options and programs, prescription drug coverage, transplant-related discharge medications, and spend down insurance plans with transplant social workers and
  other team members, as needed.
  • Demonstrates professionalism by updating knowledge via attendance at United Network for Organ Sharing (UNOS) conferences and other Financial Coordinator training, classes, seminars, conferences, in-services and other educational opportunities as appropriate and
  approved.
  • Other duties may be assigned

Education/ Experience:

• High school diploma or general education degree (GED); or on to three months related experience and/or training; or equivalent combination of education and experience.
• One-year certificate from college or technical school; or three to six months related experience and/or training; or equivalent combination of education and experience.