Transplant Financial Counselor-1

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

Job Description

Minimum Qualifications

Education:  High school diploma required.  College degree and/or TFC certification preferred.   

Licenses/Certifications: TFC certification preferred.

Experience / Knowledge / Skills:

• Three (3) years related experience (insurance, revenue cycle, transplant) required and/or training, or equivalent combination of education and experience. 
• Proficient in using Microsoft office, including Word, Excel and Power Point, as well as ability to learn and utilize, in a proficient manner, various hospital- based systems. 
• Demonstrated knowledge of the benefit structures of major health care insurance carriers and Medicare plans, as they relate to the entire transplant process, including terms of Managed Care contracts. 
• Possesses knowledge of hospital and provider billing, health plan benefit limitations, policies, procedures, and other applicable requirements and regulations of government and non-government payers and organizations. 
• Familiarity with medical terminology and coding methodologies, including CPT, ICD 10, and HCPCS.
• Ability to remain calm under pressure and deal effectively with urgent situations.
• Excellent reasoning and oral & written skills.
• Familiarity with medical terminology and working knowledge of commercial and Medicare/Medicaid benefit coverage.
• Knowledge of provider networks.
• Significant degree of independent decision making expected.
• Ability to effectively work with professionals and non-professionals in situations of high complexity and intensity in a positive and professional manner.
• Strong interpersonal skills and sensitivity in communicating with patients and their families with regard to matters of health and personal finance.
• Ability to process data and assess changes in insurance coverage trends potentially impacting the patients and programs.

Principal Accountabilities

• Obtain and verify detailed patient and/or donor insurance benefit information for all aspects of the transplant process, including, but not limited to, outpatient diagnostic services, prescription drugs, follow up clinic visits, inpatient hospital, outpatient services, and travel/lodging, provider services. 
• Obtain insurance authorizations for potential transplant recipient and/or donor transplant related services and submits clinical justification, as required, under the direction of the transplant coordinator.  Updates the clinical team regularly of all financial issues and authorizations status.
• Participate in required meetings such as Medical Review Board presentations, Multidisciplinary rounds, patient Care conferences, as directed.
• Communicate regularly with transplant team members about clearance status of patients under consideration for transplant evaluation/transplant and keeps pertinent team members apprised of coverage status and next steps undertaken if there are funding problems. Communicate directly with transplant physicians, surgeons and transplant administrative and clinical staff regarding the financial issues surrounding patient flow into the programs. 
• Re-verify insurance coverage on a consistent basis (monthly/quarterly) and updates registration data to correctly identify payer for transplant services during all phases of care.
• Collaborate with the patients, their families, and transplant team members to address insurance coverage gaps and explore alternative funding and/or service options. Advises recipients about planning for insurance coverage needs when they no longer qualify for Medicare or coverage is terminating. Communicates directly with patient and/or family when there are coverage barriers.
• Manage proper course of action for maximum reimbursement of health care charges: spend-down eligibility, COBRA coverage, determine eligibility for government assistance programs and calculate and assess discount percentages.
• Act as a liaison between patients and insurance companies to resolve reimbursement issues. Keeps track of issues that keep occurring indicating process concerns or changes in insurance company process.
• Coordinate and facilitate financial process for Transplant Services in collaboration with Contract Management, Payer Relations, Patient Accounts, Physician Billing and Reimbursement.
• Monitor and update patient insurance data and authorizations with required financial documentation in all hospital information systems and databases. 
• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as a resource to less experienced staff.
• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards of providing safe, caring, personalized and efficient experiences to patients and our workforce.
• Other duties as assigned.