Abdominal Transplant Finance Coordinator
Abdominal Transplant Finance Coordinator
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1 Vacancy
Job Description
Thank you for considering a career at Mercy Health!
Scheduled Weekly Hours:
40Work Shift:
Days (United States of America)Primary Function/General Purpose of Position
Position is accountable for evaluating clarifying and determining the financial risk involved for the Marketwide program including the physicians and patients as services are required. This includes determining the patients benefits available for evaluation preservice maintenance admission and postservice followup care; obtaining inpatient and outpatient authorizations for hospital and physician services; and ensuring necessary communication occur between the payor and the hospital for appropriate and accurate billing and reimbursement of services.
Essential Job Functions
- Obtains clarifies and documents the timely receipt of financial authorizations and benefits of patients requiring evaluations hospitalizations and all other related inpatient or outpatient services.
- Determines scope of patients benefits including but not limited to coverage for hospital physician outpatient pharmacy home health organ procurement rehabilitation and Durable Medical Equipment services.
- Obtains necessary authorizations for hospital and physician services to be provided either in the inpatient and outpatient setting. Transmits the verification numbers and billing information to the appropriate financial and preauth departments and the various physician offices.
- Performs recertification on all inpatients coordinating communications between the clinical coordinators physicians social workers the hospital utilization review coordinators the patient/family and the payor.
- Ensures interactions with third party payors case manager and contraction managers occur timely accurately and professional. These activities included but are not limited to:
- Initiates discussions with payor regarding any need for and individual contract to be negotiated as patients are referred to the program center hospital or other location. Notifies appropriate managed Care specialist who will negotiate with payors as necessary.
- Performs written correspondence to payors to obtain and to send information and letters of medical necessity and participates in onsite payor visits to the program center.
- Monitors and identifies changes in regulations and legislation with regard to Medicare of thirdparty payor reimbursement and updates program director(s) Medical Directors and any other necessary administration in a timely manner.
- Assist in the ongoing education of department staff regarding updates in contracts Medicare reimbursement and outside resources available to patients.
- Presents inservices to staff hospital financial staff and physician office staff regarding managed care updates and assists in development and implementation of communications systems to send and to receive clinical and financial data between the program center and Patients referring physicians treating physicians and payors.
- Participates in necessary professional organization meeting etc. to remain current of financial and reimbursement issues that may impact patient care.
This document is not an exhaustive list of all responsibilities skills duties requirements or working conditions associated with the job. Employees may be required to perform other jobrelated duties as required by their supervisor subject to reasonable accommodation.
Licensing/Certification
None
Education
Bachelor of Science Nursing Education/Healthcare Administration or other related field (required)
Work Experience
3 years experience in clinical health care patient accounting admitting utilization review quality assurance or case management (required)
5 years experience in clinical health care patient accounting admitting utilization review quality assurance or case management (preferred)
MercyHealth is an equal opportunity employer.
Many of our opportunities reward* your hard work with:
- Comprehensive affordable medical dental and vision plans
- Prescription drug coverage
- Flexible spending accounts
- Life insurance w/AD&D
- Employer contributions to retirement savings plan when eligible
- Paid time off
- Educational Assistance
- And much more
*Benefits offerings vary according to employment status.
Department:
Project Management Toledo Regional OfficeIt is our policy to abide by all Federal and State laws as well as the requirements of 41 CFR 601.4(a) 60300.5(a) and 60741.5(a). Accordingly all applicants will receive consideration for employment without regard to race color national origin religion sex sexual orientation gender identity age genetic information or protected veteran status and will not be discriminated against on the basis of disability. If youd like to view a copy of the affirmative action plan or policy statement for Mercy Health Youngstown Ohio or Bon Secours Franklin Virginia; Petersburg Virginia; and Emporia Virginia which are Affirmative Action and Equal Opportunity Employer please email . If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process please contact The Talent Acquisition Team at .
Required Experience:
IC
Employment Type
Full-Time
