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CommonSpirit Health Transplant Financial Counselor in HOUSTON, Texas

Overview

CHI Baylor St. Luke’s Medical Center is an 881-bed quaternary care academic medical center that is a joint venture between Baylor College of Medicine and CHI St. Luke’s Health. Located in the Texas Medical Center, the hospital is the home of the Texas Heart® Institute, a cardiovascular research and education institution founded in 1962 by Denton A. Cooley, MD. The hospital was the first facility in Texas and the Southwest designated a Magnet® hospital for Nursing Excellence by the American Nurses Credentialing Center, receiving the award five consecutive times. Baylor St. Luke’s also has three community emergency centers offering adult and pediatric care for the Greater Houston area.

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S., from clinics and hospitals to home-based care and virtual care services, CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources, CommonSpirit is committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen, both inside our hospitals and out in the community.

As a Financial counselor you will coordinate and clarify the available financial resources for patients who have been referred for Transplant services. The Transplant Financial Coordinator will be a designated member of the transplant team, working with patients and their families to coordinate the financial resources required for care, beginning with the transplant evaluation and continuing post-transplant to ensure continuity of care. This position will be a recognized member of the multidisciplinary team and will provide recommendations regarding the patient’s candidacy for transplantation and or implantation. Functions as a resource to patients and families on financial matters during the transplant process, assisting with questions concerning insurance and other financial matters. Adheres to departmental policies as it relates to pre transplant evaluation charges and appropriate identification of those for the Medicare Cost Report. Responsible for establishing the hospital’s financial expectation for the patient and/or guarantor and ensuring accurate information is exchanged which determines whether the account will be processed in an efficient and expedient manner for the hospital and the patient.

Responsibilities

  1. Obtains detailed patient insurance benefit information; medical management and transplant

  2. Discusses benefits and other financial issues with patients and/or family members during initial evaluation.

  3. Advises patients on insurance and billing issues and options. Serves as a resource for patients and their family members on financial matters.

  4. Coordinates all necessary payer authorizations including documentation of financial information appropriately in the EMR

  5. Consistently monitors and updates information regarding insurance data, physicians, authorizations and managed care contracting.

  6. Assists patients and their families with questions concerning insurance and other financial issues.

  7. Identifies and effectively communicates financial information team members, patients and their families with emphasis on identifying any potential patient out-of-pocket liability.

  8. Works with patients, their families and team members when possible to help address insurance coverage gaps via alternative funding options.

  9. Facilitates resolution of patient billing issues

  10. Ensures payers are listed Accurately, pertaining to primary, secondary, and/or tertiary coverage and billing when a patient has multiple third party/governmental payers listed on an account

  11. Processes patient accounts and deploys established policies to resolve insurance issues with patient accounts

  12. Initiates pre-cert for in-house patients when required, obtaining pre-certification reference number, approved length of stay, and utilization review company contact person and telephone number

  13. Notifies hospital Case Managers on all in-house patients regarding insurance plan changes/COB order, out of network plans, and Medicare supplemental plans that require pre-certification

  14. Contacts physician’s on scheduled patients, to notify them of authorization requirements and any possible financial holds

  15. Analyzes reports to ensure admission dates for patient type changes are accurate in order for the account to appear on insurance verification reports

Qualifications

Education and Licensure Required:

High School Diploma/GED

Two years of related experience

Preferred experience in insurance verification, follow up and billing in a hosptial environment, customer service

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Requisition ID 2021-162383

Employment Type Full Time

Department Organ Transplant - Lung

Hours / Pay Period 80

Shift Day

Standard Hours 8A - 5P

Facility / Process Level : Name CHI Baylor St. Luke's Medical Center

Location TX-HOUSTON

Equal Opportunity CommonSpirit Health™ is an Equal Opportunity/ Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law.

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