Lahey Health Coord Transplantation Finance in Burlington, Massachusetts
Lahey Health is a vibrant and growing health care system, recognized as a trailblazer in medicine and a standard bearer in patient experience. It includes an award-winning academic medical center, a superb constellation of community hospitals, home care services, rehabilitation facilities and more.
We are committed to attracting, developing and retaining top talent in a market long recognized and revered as a global leader in health. With a team approach to care, we encourage learning and growth at all levels, and we offer competitive salaries and benefits. We adhere to the principles of a just and fair work environmentfor all colleagues, where respect is foundational and performance is rewarded.
About the Job
Essential Duties & Responsibilities: including but not limited to:
Meet and interview all kidney and liver transplant candidates.
Performs financial screening/interview of all patients presenting for transplantation. Researches and verifies insurance for hospital, professional and pharmacy coverage, especially immunosuppressive medications. Utilizes critical thinking to ensure patients are financially able to proceed with transplant.
Assists finance department and managed care area by providing data about transplant program and financial activities to support insurance contacts. Implements and coordinates the reimbursement of approved transplant contracts with the Contracting Department. Acts as the departmental liaison between Contracting and insurance companies when establishing single case rates.
Pre-certify coverage for all transplant procedures, confirming prescription coverage. Recertify on a yearly basis.
Keeps up to date on job related regulations to ensure maximum financial coverage for patients and appropriate reimbursements. Adheres to regulations regarding transplantation including but not limited to CMS, UNOS and Joint Commission.
Acts as a contact for insurance case managers primarily, but limited to, obtaining pre-certification. Collects and submits necessary documentation and correspondence. Performs and communicates related follow-up.
Work closely with specialty pharmacies to ensure appropriate coverage for transplant medications.
Obtain preauthorization on medications as necessary for all Hepatology, pre and post transplant patients and private liver patients.
Help patients find pharmacy assistance programs when necessary.
Notify team of any insurance or financial problems which may preclude patients from being listed.
Help patients with insurance choices, Medicaid applications and disability.
Meet with live liver/kidney donors, explaining billing process. Work closely with PFS to ensure donors do not receive bills.
Obtain referrals where necessary. Communicate with billing on patient issues, contract information and payments.
Responsible for billing of multidisciplinary liver clinic and nurses visits. Oversee end of month charges are completed for all clinic visits in department.
Participate in Revenue Cycle Meeting, tracking payments on transplant patients.
Ensure contract is in place for transplant candidates. Communicate with our contract manager any concerns or problems and notify him/her of any new contract which may be necessary.
Give cost (charge) estimates to self-pay patients with their insurance information. Meet with enhancement group to establish correct payment.
Actively participates and contributes to weekly department meetings.
Discusses patient problems resulting from collection notices, statements and other Lahey related billing and insurance issues.
Assists patients with free care and Medicaid application process.
Updates case managers for reauthorization and notifies them of transplants.
Approve all donor acquisition charges for appropriate processing..
Review and approve invoices from the New England Organ Bank for payment and for inclusion on patient’s transplant claim.
Meet regularly with Finance to improve business policies and procedures to ensure proper billing for the Medicare cost report.
Establish payment system with outside institutions for transplant workups, ensuring that they will accept Medicare rate of reimbursement for these services.
Keep accurate spread sheets for all pre and post transplant patients.
Approve all outside transplant workup invoices, ensuring they are billed at the appropriate rate.
Completes Medicare time studies in a timely manner for inclusion on the Medicare cost report.
Authorize payment for all HLA typing invoices.
Work with Finance and Billing to establish a system to approve all pre-transplant charges for inclusion on the Medicare cost report. This entails reviewing thousands of transplant claims to ensure they are evaluation vs treatment.
Work with the International Office to ensure proper accounts are established for pre-payment on all transplant patients.
Education: High School Degree required, Bachelor’s Degree preferred
Licensure, Certification, Registration: NA.
Skills, Knowledge & Abilities: Requires a broad and thorough knowledge of patient accounting and healthcare Proficiency is required in the use of Microsoft Office. Must have strong organizational skills and the ability to prioritize demands. Proficiency in communicating verbally and in writing with varied internal and external groups is required.
Experience: Two years related experience in hospital billing and/or insurance environment. Preferred Transplant experience in transplant .