Transplant Financial Spclst
Transplant Financial Spclst
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Salary Not Disclosed
1 Vacancy
Job Description
Overview
Houston Methodist Standard
Refer to departmental Scope of Service and Provision of Care plans as applicable for description of primary age groups and populations served by this job for the respective HM entity.
HOUSTON METHODIST EXPERIENCE EXPECTATIONS
- Provide personalized care and service by consistently demonstrating our I CARE values:
- INTEGRITY: We are honest and ethical in all we say and do.
- COMPASSION: We embrace the whole person including emotional ethical physical and spiritual needs.
- ACCOUNTABILITY: We hold ourselves accountable for all our actions.
- RESPECT: We treat every individual as a person of worth dignity and value.
- EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.
- Practices the Caring and Serving Model
- Delivers personalized service using HM Service Standards
- Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET Managing Up Key Words)
- Intentionally collaborates with other healthcare professionals involved in patients/customers or employees experiential journeys to ensure strong communication ease of access to information and a seamless experience
- Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job
- Actively supports the organizations vision fulfills the mission and abides by the I CARE values
Responsibilities
- Promotes a positive work environment and contributes to a dynamic team focused work unit that actively helps one another to achieve optimal departmental and organizational results.
- Consults with clinical transplantation staff including coordinators and physicians in order to facilitate the submission of required medical documentation to insurance carriers.
- Employs a high degree of professionalism and effectively engages with a diverse customer base including patients/visitors physician office staff and representatives from internal departments and external organizations. Gives appropriate status updates.
SERVICE ESSENTIAL FUNCTIONS
- Meets with patients and/or family members to discuss benefit coverage and potential financial issues regarding the transplant process. Takes necessary steps to make certain arrangements/plans are made to meet financial requirements on a per case basis. Provides information regarding available resources.
- Consults with uninsured or underinsured patients and/or family members on resources for financial benefits.
- Contributes to departmental and hospital patient experience. Proactively seeks solutions to address patient and visitor issues and concerns. Alerts management in a timely manner to any unusual and/or difficult situations impacting the level of service.
QUALITY/SAFETY ESSENTIAL FUNCTIONS
- Monitors and reports status of the financial clearance process and facilitates peertopeer and appeal processes.
- Continually monitors and reviews the transplant evaluation and admission account for accuracy so that services are paid or reimbursed appropriately. Updates electronic medical record with appropriate financial data such as a bundled episode as applicable. Takes appropriate followup action to resolve problems.
- Maintains log of patients referred for evaluation and of transplant financial clearance. Notifies coordinator and assists with obtaining reauthorization if necessary either at time of insurance change or expiration of authorization. When applicable closes out the transplant episode and notifies appropriate parties that patient is no longer a transplant candidate.
FINANCE ESSENTIAL FUNCTIONS
- Works with hospital financial counseling to obtain and maintain single case agreements.
- Conducts benefit analysis and verification of patients insurance coverage and obtains authorization for transplant related services.
- Creates and maintains transplant notification form (TNF).
- Utilizes resources effectively and efficiently demonstrating responsible financial stewardship. Manages own time effectively and prioritizes work to achieve maximum results in a timely manner.
GROWTH/INNOVATION ESSENTIAL FUNCTIONS
- Displays initiative to improve job functions. Demonstrates adaptability and flexibility during changing demands. Offers suggestions to streamline process for efficient patient flow.
- Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development.
This job description is not intended to be allinclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.
Qualifications
- Associates degree required or additional two years of experience (in addition to the minimum experience requirements listed below) required in lieu of degree
WORK EXPERIENCE
- Three years of experience in a hospital business office or related financial setting
License/Certification
- N/A
KSA/ Supplemental Data
- Demonstrates the skills and competencies necessary to safely perform the assigned job determined through ongoing skills competency assessments and performance evaluations
- Sufficient proficiency in speaking reading and writing the English language necessary to perform the essential functions of this job especially with regard to activities impacting patient or employee safety or security
- Ability to effectively communicate with patients physicians family members and coworkers in a manner consistent with a customer service focus and application of positive language principles
- Strong verbal and written communication and interpersonal skills to interact effectively with patients patients representatives thirdparty payers and colleagues with varying professional backgrounds in the resolution of reimbursement for transplant services
- Knowledge of payer requirements authorizations and insurance terminology
- Proficient understanding of medical terminology and diagnosis/procedural codes
- Comprehensive knowledge of state and federal regulations relevant to role
- Ability to analyze and solve problems
- Welldeveloped organizational skills with ability to multitask and utilize time efficiently
- Ability to adapt to changes in the work environment and modify approaches or methods to best fit the patients situation
- Ability to remain calm in stressful situations with patience and understanding
- Proficient computer skills in Microsoft Word and Excel and ability to learn and navigate multiple software programs and payer websites
- Ability to handle detail work accurately and rapidly
- Bilingual skills (English/Spanish) preferred
SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE
- Uniform No
- Scrubs No
- Business professional Yes
- Other (department approved) No
ONCALL*
*Note that employees may be required to be oncall during emergencies (ie. DIsaster Severe Weather Events etc) regardless of selection below.
- On Call* Yes
TRAVEL**
**Travel specifications may vary by department**
- May require travel within the Houston Metropolitan area No
- May require travel outside Houston Metropolitan area No
Company Profile
Since its founding in 1919 Houston Methodist Hospital has earned worldwide recognition. Houston Methodist Hospital is affiliated with the Weill Medical College of Cornell University and New YorkPresbyterian Hospital one of the nations leading centers for medical education and research. In 2020 U.S. News & World ReportnamedHouston Methodist Hospitalto its top ranked Honor Roll for the fourth time and second consecutive year. 2020 also marked the ninth year in a row Houston Methodist Hospital has been named the No. 1 hospital in Texas. Houston Methodist Hospital directs millions of research dollars into patient care and offers the latest innovations in medical surgical and diagnostic techniques. With 952 operating beds 85 operating rooms and over 8000 employees Houston Methodist offers complete care for patients from around the world.
The same highquality care for which Houston Methodist is known is available at several Emergency Care Centers in Houston and the surrounding areas. These Emergency Care Centers house exam rooms full digital radiography suite low radiation dose 16slice CT scan ultrasound and a full onsite stat chemistry lab.
Employment Type
Full-Time
