Transplant Financial Counselor I

Overview

Be inspired. Be rewarded. Belong. At Emory Healthcare.

At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide:

• Comprehensive health benefits that start day 1
• Student Loan Repayment Assistance & Reimbursement Programs
• Family-focused benefits
• Wellness incentives
• Ongoing mentorship, development, and leadership programs
• And more

Description

Job Summary

• Under direct supervision, ensures optimal insurance coverage and payments for all pre, transplantation, and post-transplant patient services for designated organ program.
• Obtains detailed patient insurance benefit information including, but not limited to: outpatient prescription drugs, organ acquisition, follow-up clinic visits, and travel and housing if necessary.
• Researches type of coverage, limitations and exclusions for appropriateness according to the transplant program financial criteria.
• Works collaboratively with the insurance companies to obtain authorization for a transplant and to identify out-of-pocket expense for the patient.
• Discusses benefits and other financial issues with patients and or family members during initial evaluation.
• Serves as a resource for patients, family members, Social Workers, Coordinators, Physicians and Administrative staff on financial matters.
• Serves as a resource to transplant candidates with respect to alternate funding and choices of insurance coverage, i.e., Medicare and Medicaid eligibility, COBRA, Social Security Disability, retirement plan, etc. Retrieves any clinical data required by third party payers, and makes sure that such are available to payers in a timely manner if requested.
• Serves as a resource to the transplant team, and provides explanation to clinical and administrative staff in regards to transplantation review and reimbursement criteria.
• Under direct supervision interprets and applies Centers for Medicare and Medicaid Services regulations/guidelines related to transplant services.
• Under direct supervision, follows up on all accounts assigned prior to, during, or after admission and discharge correcting account errors.
• Prepares, verifies, researches, and completes all paperwork/written correspondence and forms to ensure accurate authorization for transplant services.
• Serves as a patient advocate during the cycle of the account. Reviews all accounts assigned for collection prior to, during, or after admission and discharge.
• Verifies insurance as needed to resolve account balances.
• Responsible for handling and resolving incoming customer inquiries / or concerns by providing patient/guarantor from physician practices with a consistent and seamless experience.
• Drive volumes and increase revenue by obtaining Pre-Authorization for various outpatient/inpatient transplant services in a timely Manner. Responsible for operating imaging tools for use in the creation of electronic files or archives.
• Responsible for preparing, scanning, and indexing documents/images being converted to electronic/digital format.

MINIMUM QUALIFICATIONS

Education

• High school diploma required.

Experience

• Three (3) years experience in healthcare patient financial services or insurance setting OR five (5) years experience in healthcare setting required.
• Knowledge of Centers for Medicare and Medicaid Services regulations related to transplant services or obtain training within first 6 months of employment.
• Third party payor experience preferred.

PHYSICAL REQUIREMENTS (Medium Max 25lbs): up to 25 lbs., 0-33% of the work day (occasionally) Lifting 25 lbs. max; Carrying of objects up to 25 lbs.; Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks. ENVIRONMENTAL FACTORS: Factors affecting environmental conditions may vary depending on the assigned work area and tasks. Environmental exposures include but are not limited to: Blood-borne pathogen exposure, Bio-hazardous waste chemicals/gases/fumes/vapors, Communicable diseases, Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.

Additional Details

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare’s Human Resources at careers@emoryhealthcare.org. Please note that one week's advance notice is preferred.