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GENERAL SUMMARY:

Under general supervision, responsible for ensuring that insurance coverage is available, and the scope of patient benefits are identified prior to services being rendered. Accountable for investigating and confirming coverage for provider evaluations, identified ancillary testing and surgeries for transplants and appropriate non-transplant surgeries. Provides component from financial perspective if patients are eligible to be listed according to Transplant Institute and programmatic policy.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

· Verify insurance coverage eligibility of patients prior to scheduling and delivery of services.

· Determine the scope of benefit coverage for services including areas such as hospitalization, professional services, pharmacy, home health, rehabilitation, DME and organ procurement limitations.

· Coordinate the activities to obtain pre-authorization for appropriate services including clinical input, patient financial commitment amounts, eligibility periods, CPT and ICD-10 information and relevant patient compliance information.

· Maintain adequate communication channels with third party payers and internal clinical departments.

· Serve as an intermediary amongst the patient and/or family members, insurance companies and clinical areas to assist in obtaining necessary insurance coverage and authorization information. Attend organ team selection meetings to represent financial perspective of patient eligibility for organ listing.

· Process and coordinate the resolution of assigned work queues in Epic to assist in the processing of claims.

· Serve as a resource to inform patients and their families of the Transplant Institutes financial policies and outstanding obligations related to financial clearance.

· Meet with patients and their families to discuss financial information relative to pre [1] transplant processes, or, if transplanted, post-transplant coverage.

· Maintain regular and timely eligibility verifications on listed patients that are becoming more likely to be transplanted.

· Perform regular reviews of eligibility for elective surgical candidates for identified non-transplant patients.

· Maintain documentation of all financial communications and “touches” on patient statuses. Contact referring physicians for necessary patient information to process financial determination

· Work in support of the Transplant Institute financial area to review outstanding claims, underpayments, and single case agreements.

· Serve as a resource relating to insurance questions from various internal HFH areas.

· Develops and maintains an adequate understanding of managed care, CMS and UNOS guidelines relative to transplantation and financial involvement,

· Represents HFH to external agencies on issues involving admissions, financial policies and procedures. 18.Contact insurance company’s case managers for expedited and emergent requests for transplant authorizations.

· Participates in ongoing efforts of the Transplant Institute to increase efficiencies and quality through LEAN processes.

· Regularly attends and participates in the Transplant Institute’s monthly staff meetings.

· Perform ad hoc and special projects as assigned.

EDUCATION/EXPERIENCE REQUIRED:

• High school diploma or G.E.D. equivalent.

• Associates degree is preferred. General knowledge base of billing requirements and rules.

• Comprehensive knowledge of insurance coverage generally obtained through three (3) or more years of relevant experience, preferably in a hospital setting.

• Extensive knowledge of various insurance coverage, COB rules of priority and processing procedures.

• Basic computer skills required to operate a personal computer.

• Organizational and time management skills required in order to maintain and prioritize daily work, weekly reports and to follow-up on accounts in a timely manner. Ability to work in self-directed environments.

Additional Information

• Organization: Henry Ford Hospital - Detroit Main Campus

• Department: Transplant Admin

• Shift: Day Job

• Union Code: Not Applicable

  Additional Details

  This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.

Overview

Partnering with nearly 2 million people on their health journey, Henry Ford Health provides a full continuum of services at 250 care locations throughout southeast and south central Michigan. With 33,000 valued team members, Henry Ford is also among Michigan’s largest and most diverse employers. Our superior care and discoveries are powered by nearly 6,000 physicians, researchers and advanced practice providers. Learn more athenryford.com.

Benefits

Whether it's offering a new medical option, helping you make healthier lifestyle choices or making the employee enrollment selection experience easier, it's all about choice. Henry Ford Health has a new approach for its employee benefits program - My Choice Rewards. My Choice Rewards is a program as diverse as the people it serves. There are dozens of options for all of our employees including compensation, benefits, work/life balance and learning - options that enhance your career and add value to your personal life. As an employee you are provided access to Retirement Programs, an Employee Assistance Program (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness, and a whole host of other benefits and services. Employee's classified as contingent status are not eligible for benefits.

Equal Employment Opportunity/Affirmative Action Employer

Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.