Transplant Financial Service Representative

The Transplant Financial Services Representative is responsible for providing accurate financial clearance to patients seeking transplant services at Children's Hospital Colorado (CHCO) and conducting billing and collections with third party payers for global payments. This position is responsible for the analysis, validation and regulatory/compliance activities associated with the financial clearance process for transplant patients. Mitigates the financial risk to CHCO and University Physicians, Inc. of transplant patients by performing accurate financial clearance review along with a comprehensive analysis of patient and payer specific benefits and patient liability. Coordinates and communicates with the patient and clinical teams including physicians, transplant nurse coordinators, social workers and pharmacists, as well as members in the Managed Care and Revenue Cycle departments.

Additional Information
Department Name: AMC Patient Access
Job Status: Full time, 40 hours per week.
Shift: Monday to Friday, 8am to 5pm, Hybrid.

Duties & Responsibilities

• Analyzes, organizes, and utilizes data and rules related to contracting and patient benefits to provide financial clearance for all transplant patients.
• Attends required staff meetings, respective transplant clinical meetings, and payer meetings. Educates internal CHCO constituents as needed.
• Identifies professional development opportunities surrounding financial counselor educational sessions, and transplant regulatory/policy training. Identifies operational improvements to maximize efficiency and effectiveness of services provided. Communicates opportunities to management.
• Position may be subject to responding to urgent or emergent transplant team requests. Position requires participation with on call coverage for after hour and weekend request for financial clearance request.
• Interacts with transplant clinical teams to obtain treatment plans, discharge planning, concurrent and retrospective review and patient demographics to begin insurance verification process. Under moderate supervision, interviews admitted patients to obtain required information to begin verification. Interacts with transplant clinical teams prior to a patient's financial clearance, providing key information and data regarding benefits, support and patient financial liability.
• Develops and shares weekly patient financial clearance report with the transplant administrative and/or clinical teams. Analyzes benefit requirements and initiates the request for authorization/prior approval for the transplant evaluation, admission, clinic visits, donor compatibility, work-up and testing, organ procurement, ventricular assist devices and follow-up appointments.
• Prepares the medical packet (including letter of medical necessity and clinical evaluation) required for obtaining prior approval, authorization, or pre-certification. Documents authorizations and other required information in EPIC per policy and procedure. Reviews denials for evaluation and/or transplant and initiate the appeal process with the insurance payer working collaboratively with the patient, family, and physician.
• Regularly monitors and works transplant tickler as it relates to waitlisted transplant patients to ensure authorizations are kept current. Performs on-going financial review /analysis of patient's eligibility, benefit changes and financial status once a patient is accepted for evaluation through one-year post-transplant.
• Under moderate supervision, meets with patients and family members at the time of transplant evaluation; informs patients of the anticipated costs of transplant services, the anticipated patient liability, and the patient responsibilities (e.g. post-transplant medications).
• Assists patients with a financial plan and directs to financial resources when not adequately funded for transplant (e.g. fundraising). Implements appropriate collection actions and assists financially responsible persons in arranging payment. Notifies the transplant clinical team of financial considerations that prevent or delay listing the patient for transplant or impact care coordination, specifically coordination around discharge planning and post-transplant care.
• Reviews each patient visit to determine if a visit was transplant related in order for accurate billing to occur. Communicates with the clinicians to confirm visit requirements. Coordinates global billing for transplant cases from claim submission to final payment; provides follow-up with payers, providing information, corrections, and problem resolution. Facilitates payment to University Physicians, Inc. for the professional component of global bills.
• Processes invoices related to organ procurement vendor(s) and makes required accounting documentation and/or reporting. Develops invoices related to services rendered to CHCO patients at other facilities and monitors payments through closure.

Minimum Qualifications

• Degrees
  • Bachelor of Business
• Area of Study
  • or related field.
• Experience
  • Minimum Experience. Required:Two (2) years of healthcare experience in a financial counseling role with insurance authorization, third party reimbursement and eligibility requirements for all subsidy programs.
• Equivalency
  • Four years experience above stated requirements may substitute for bachelor's degree.
• Licenses & Certifications
  • None
• Additional Requirements
  • Not Applicable.
• Competency
  • None

Salary Information
Pay is dependent on applicant's relevant experience.

Annual Salary Range (Based on 40 hours worked per week): $61,473.39 to $92,210.08

Benefits Information
Here, you matter. As a Children's Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid time off, medical/dental/vision insurance, company provided life and disability insurance, paid parental leave, 403b employer match (retirement savings), a robust wellness program, and access to professional development tools, including an education benefit to help you advance your career.

As part of our Total Rewards package, Children's Colorado offers an annual employee bonus program that rewards eligible team members based on organizational performance. If organizational goals are met for the year, the bonus is paid out the following April.

Children's Colorado delivers annual base pay increases to eligible team members based on their performance over the previous year.

EEO Statement
It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. Be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information. The position is expected to stay open until the posted close date. Please submit your application as soon as possible as the posting is subject to close at any time once a sufficient pool of qualified applicants is obtained.

Colorado Residents: In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of attendance at or graduation from an educational institution. You will not be penalized for redacting or removing this information.