As a member of the transplant team, the Transplant Financial Case Coordinator manages and/or coordinates all financial issues with patients, insurers, referring and attending physicians, nurse coordinators, social workers and other stakeholders
Perform insurance verification and analysis as described below:
Determine eligibility status,
Obtain benefit information,
Verify group/contract numbers and subscriber information, and
Verify applicable contract and/or network.
Includes facility, physician, home health care, home infusion, pharmacy, and travel/meals/lodging benefits as appropriate
Obtain certification and/or authorization of admission or service and furnish necessary information to utilization review for concurrent review.
Identify potential coverage issues and works with:
Specific Fairview program (UMP, HHC, IV, Rx),
Insurance company, and
Research to find other programs for payment and/or negotiate with third party payers to provide coverage by submitting medical data, citing precedents set by other payers and providing cost benefit information.
Maintain current knowledge of payer requirements and general admitting practices including use of on-line verification applications and initial and ongoing training.
Provide financial counseling and support for patients as needed during the course of their treatment. Assist in resolving problems with payers and provide information and expertise to other departments.
Demonstrate ability to provide care or service adjusting approaches to reflect developmental level and cultural differences of population served.
Demonstrate ability to counsel patients with billing inquiries
Provide itemizations to patients and/or social workers as requested
Direct patients to the correct billing entity, as appropriate
Coordinate with other billing entities to provide financial answers to patient inquiries
Secure services associated with potential transplant patients
Pocket controllers and supplies for DT-VAD patients
Determine need for a financial exception
Coordinate with physician and/or nurse coordinator to determine the sponsorship and outline of financial exception
Work with UMP to draft FE and obtain signatures
Coordinate with billing office to apply FE standards to billing
Work with potential international and self-pay patients
Create customized estimates based on medical services provided
Work with patients/families/embassies to collect deposits
Work with the billers to understand the distribution of funds
Work with patients/families/embassies to collect additional funds as needed
Provide documentation needed to patient/family/embassy (itemizations, bills, etc.)
Request deposit refund be submitted to patient/family/embassy if funds are remaining after patient is discharged from care
Coordinate with all providers of service
Confirm enrollment with atypical insurance providers
Negotiate rates for reimbursement for financial exceptions
Confirm acceptance of insurance rates
Including but not limited to UMP, HHC, IV, Rx
Kidney Paired Donation (KPD)
Secure coverage for recipient at UMMC
Coordinate with other facility or facilities involved in the KPD to ensure that their recipient has insurance for our donor
Coordinate with other facility or facilities involved in the KPD to ensure that the other facility accepts the insurance of our recipient for their donor
Counsel patient(s) involved as necessary, including Medicare education
Retroactively secure insurance coverage for patients transplant prior to securing financial resources
Counsel patients on insurance options
Work with other providers of service (UMP, HHC, IV, Rx) to navigate coverage gaps
Assist patients with navigating insurance options
Research supporting clinical and non-clinical documentation in an attempt to gather as much information as possible to secure coverage for transplantation (including but not limited to research journals, articles, etc.)
BA/BS degree in business, communications or liberal arts fields or equivalent combination of education and experience
BA/BS degree plus 2-3 years of experience (or equivalent combination of education and experience) in healthcare or insurance organizations related to admitting, billing, claims processing, financial counseling, collections, contracting.
Strong knowledge of computer systems. Knowledge of EPIC System and Transplant Services experience preferred.
Knowledge of PASS System; knowledge of transplant services.
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.
Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.
Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider network and health insurer PreferredOne. In partnership ...with the University of Minnesota, Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.