Transplant Financial Coordinator

Registered Nurse Position at University of Maryland Medical Center

University of Maryland Medical Center (UMMC) is looking for extraordinary Registered Nurses (RNs) to join our nursing team. Come elevate your skills and experience by working with a world-class, Magnet® designated (3 times in a row) Academic Medical Center. UMMC is the flagship academic medical center at the heart of the University of Maryland Medical System (UMMS) located in downtown Baltimore.

Responsibilities

• Communicates with clients to determine their insurance coverage and potential eligibility for insurance or particular programs to expedite payment for the care coordination services and related medical needs.
• Notifies insurance case manager concerning clinical testing updates and patient admissions and discharges. Schedules outpatient visits, tests and procedures as required.
• Educates patients regarding adequate insurance coverage. Understands hospital and physician billing requirements and communicates the proper procedures and requirements to patients.
• Initiates problem solving and resolution of insurance barriers to ongoing care, including assisting potential clients with identifying and applying for alternative financial aid or charity programs when available.
• Assess and screen the patient for presumptive charity, financial assistance, and Medical Assistance.
• Review all patients' prior multi accounts specifically, but not limited to a prior inpatient account to get previously obtained information documented by the MAE/FA team to assist the coordinator in making determination.
• Communicate recommended determination to referring party and forward patient/account to applicable patient financial services department representative for final decision.
• Verifies insurance benefits and coverage by contacting insurance companies to determine necessity for co-payments, deductibles, and advance deposits. Discusses coverage and self-pay responsibility with clients.
• Identifies patterns in referral and charging workflows contributing to potential sources of revenue loss based on in-network scheduling constraints, payer denials, inadequate contract pricing, regulatory rules or other reasons resulting in UMMC being the payer of last resort. Collates specific information at the patient and aggregate level that enables the organization to articulate these challenges to internal and external audiences.
• Identifies the payer requirements and additional information necessary to process a request for approval. Submits required information and documentation. Follows up in a timely manner and documents appropriately in the patient record. Improves overall authorization rates within the hospital and professional billing systems.
• Ensures that the process for obtaining authorization is followed with the individual payers. Notifies management of problem accounts that hold a risk of financial loss. Develops and maintains records for the primary and any secondary coverage, contact information for the payers, and reviews and updates the financial information on a routine basis following the outlined procedures for documentation.
• Communicates coverage issues to the care coordination/outpatient center clinical staff; works with patients and staff to resolve.
• Develops and maintains financial reference guides, including guidelines for reimbursement, State and Federal regulations, and payer specific policies. Maintains current updates received from third party payers referencing authorization and reimbursement requirements.
• Participates in specific Care Coordination/Outpatient Center team meetings, presents financial concerns surrounding known payer requirements for discussion by the team.
• Documents key steps throughout the authorization process in the electronic health record. Enters and updates key reimbursement information.
• In conjunction with medical staff, develops letters of necessity and responds to requests for additional information from third party payer pre-certification staff and case managers to help assure maximum consideration for authorization and eventual reimbursement.
• Develops and maintains reports on workload volumes and results as requested.
• Cross covers for vacancies or staff absences and assumes additional workload as needed.
• Serves as a resource for those within and outside the program.

Work Experience

• Knowledge of insurance verification and hospital registration and electronic medical record systems.
• Familiarity with the operation of personal computers and a basic knowledge of peripheral equipment.
• Effective written and verbal skills are required to assist management in the creation and explanations of reports generated from the data management and reporting.
• Proficiency in word processing and database software.
• Ability to demonstrate knowledge and skills necessary to provide care appropriate to the patient population(s) served.
• Ability to demonstrate knowledge of the principles of growth and development over the life span and ability to assess data reflective of the patient's requirements relative to his or her population-specific and age specific needs.
• High school diploma or equivalency (GED) required. Bachelor's degree in business or related field is preferred.
• Three years' experience in financial counseling in a hospital business office or other healthcare setting is required.
• Experience with Epic registration preferred.