Children’s Hospital of Michigan is an international leader in pediatric and adolescent medicine. Surgical services include general, thoracic, reconstructive and cardiovascular. Imaging technology designed specifically for children provides advanced diagnostic services including Positron Emission Tomography (PET) and MRI. The Children’s Hospital of Michigan Emergency Department is a verified Level 1 Pediatric Trauma Center and dedicated pediatric burn center. Experts in pediatric critical care, rehabilitation, and neonatal and perinatal medicine provide care for thousands of children every year at Children’s Hospital of Michigan, Children’s Hospital of Michigan - Troy and six ambulatory sites.

Job Summary

Under general supervision, maximizes financial reimbursement for transplant services rendered. Identifies financial liabilities and ensures adequate insurance benefits or funding arrangements are in place prior to transplantation.

In accordance with established policies and procedures, identifies/determines the accuracy and completeness of relevant financial, insurance and/or demographic information for transplant-related outpatient encounters and the inpatient transplant admission to ensure accounts are secure prior to discharge.

Advises, educates and serves as a resource and financial counselor to transplant candidates, their families and live donors regarding payor transplant benefits, billing issues, alternative funding options and personal responsibilities.

Acts as a resource to the program director and transplant team, in addition to the Admitting, Contracting, Transplant Clinic, Patient Accounting and Reimbursement staff, regarding candidates financial status and payor benefits.

Obtains all necessary information (e.g., benefit verification, payor authorizations, referrals, pre-certification and case management) required by payors. Identifies administrative/financial problems involving reimbursement and interfaces with relevant administrative and clinical staff and departments for resolution.

Assists in monitoring candidate and live donor encounters for purposes of acquisition cost center administration. Develops and recommends procedures associated with transplant administrative and fiscal matters.

Demonstrates an understanding of and commitment to the philosophy, standards, objectives and policies of the transplant program and Detroit Medical Center organization.

1. Interviews transplant candidates to assess financial status and collect data concerning insurance coverage. Enters data collected into transplant database, other databases (e.g., LINK, CIS, OTG, CAPSTONE, PTIQ) and patient chart, as appropriate; regularly updates the information ensuring currency and accuracy. Makes rapid decisions regarding the financial clearance of potential transplant patients based on information gathered. Maintains candidate, donor and employee confidentiality in the management of information.

2. Educates transplant candidates regarding the Medicare and Medicaid application process(es) and program coverage; provides information, as appropriate. Assists with applications, eligibility guidelines and billing issues. Apprises patients of the interrelationship of payors: government, third party and their personal financial responsibility. Keeps apprised of changes in federal and state guidelines related to organ transplantation and communicates changes to Director, Transplant Team and applicable DMC departments

3. Contacts commercial carriers, third party and managed care payors; and, as appropriate, international insurances and foreign embassies are contacted, to research and verify patient eligibility, type of coverage and level of benefits. Monitors primary payors based on the End Stage Renal disease rule.

4. Together with DMC Contracting Department, compares insurance benefits with DMCs transplant-specific contracts in order to secure approval of the transplant evaluation. Keeps current on all DMC managed care contracts related to transplant and other services, as well as federal and state guidelines related to organ transplantation.

5. Participates in transplant candidate and live donor orientation sessions and acts as a resource to the transplant candidate, family and live donor on billing problems. Serves as a financial resource to self-pay transplant candidates; discusses financial alternatives; explores funding arrangements. Researches, coordinates and shares information about self-pay funding options and programs, prescription drug coverage, transplant-related discharge medications, and spend down insurance plans with transplant social workers and other team members, as needed.

6. Verifies transplant candidate insurance status and benefits on a monthly basis and maintains accurate and current patient financial information.

7. Reviews program financial performance, billing and reimbursement. Monitors all pre-transplant encounters for appropriate cost reporting and billing.

8. Demonstrates professionalism by updating knowledge via attendance at United Network for Organ Sharing (UNOS) conferences and other Financial Coordinator training, classes, seminars, conferences, in-services and other educational opportunities as appropriate and approved.

9.Participates in departments performance improvement activities.

1. Completion of a high school diploma or GED equivalent is required. Associates degree in business or healthcare field with coursework in accounting, business, healthcare administration, or equivalent, with strong computer skills, is required or equivalent combination of education and/or experience. Bachelors degree preferred.

2. Two years experience in hospital, medical accounting, third party billing, public contracting and business required.

3. Knowledge and comprehension of medical billing, bundled billing, insurance verification processes and multiple insurance plan standards and regulations.