Major Responsibilities:

• Performs and generates timely documentation of comprehensive financial assessment(s). Obtains insurance prior authorizations for high dollar medically necessary transplant evaluation, transplant, BTT VAD and DT VAD.
• Meets with patient during evaluation process to discuss transplant benefits, obtaining necessary information to determine areas of potential concern. Counsels and assists patients with decisions when insurance clearance is not obtained. Collaborates with the multi-disciplinary team in establishing/documenting goals and treatment plans for the patient. Meets with all potential living donors prior to the Selection Committee decision to review potential financial impact and pursues potential financial assistance resources.
• Participates in transplant team meetings. Establishes and maintains a working relationship with key contacts at insurance companies and other departments within the Aurora Health Care system.
• Communicates and coordinates with medical staff to provide up to date and accurate interpretation of patient's medical status to insurance case managers.
• Collaborates with members of the transplant team to problem solve post-transplant medication issues. Pursues alternative funding resources for insurance coverage deficiencies, and completes all necessary applications and paperwork for pharmaceutical funding assistance programs. Provides ongoing patient education and support for transplant, VAD, Advanced Heart Failure (HF) Clinic and general surgical patients.
• Performs crisis intervention when financial issues arise post VAD implant/transplant. Follows up with patient in clinic or the bedside to assess financial needs/concerns, and make referrals as necessary. Participates in patient advocacy, resource brokering, and information and referral services. Serves as general advocate for patients and their families throughout the pre-and post-transplant process.
• Maintains current knowledge of Medicare and Medical Assistance rules or any federal and state legislation affecting the transplant patients. Understands out of state Medicaid, Exchange plans and commercial payer networks including prescription drug provider networks in order to ensure proper coordination. Coordinates housing accommodations for patients.
• Maintains up to date documentation for all organ transplant listed patients, for the purpose of transplant re-authorizations and insurance changes. Communicates patient transplant contract information and coordinates patient contract billing issues to Transplant Billing Group. Facilitates and advocates a resolution of patient billing issues. Tracks monthly time study.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• Associate's Degree (or equivalent knowledge) in Medical Billing or related field.

Experience Required:

• Typically requires 5 years of experience in medical insurance benefit coverage assessment, processing and invoicing; including HMO and PPO experience.

Knowledge, Skills & Abilities Required:

• Knowledge of Medicare/ESRD rules
• Understanding of Marketplace regulations specific to transplant
• Independent discretion/decision making skills
• Ability to effectively work with professionals and non-professionals in situations of high complexity and high intensity in a positive and professional manner.
• Strong analytic, organization, communication (written and verbal), and human relation skills
• Strong interpersonal skills and sensitivity with patients and their families with regard to matters of health and personal finance
• Ability to plan, organize, prioritize, multi-task, and meet deadlines under stressful circumstances
• Knowledge of computer applications related to patient accounts processing
• Knowledge of medical terminology
• Knowledge of principles and practices of customer service and telephone courtesy

Physical Requirements and Working Conditions:

• Position requires travel; therefore, incumbent may be exposed to road and weather hazards.
• Must be able to sit the majority of the workday.
• Occasionally lifts up to 10 lbs. when moving/lifting manuals and binders.
• Exposed to a normal office environment.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.