Transplant Finance & Authorization Specialist

MedStar Health; Washington (District of Columbia); On-site; USD 60,000 - 102,000; Full time

Job summary

Georgetown University Hospital is seeking a Financial Coordinator for Bone Marrow and Stem Cell Transplant services to evaluate insurance coverage and assist in pre-authorization for transplant procedures. You will help ensure maximum reimbursement and guide patients to obtain resources for care, while coordinating cost-reduction opportunities and quality-improvement recommendations.

You will interact with medical staff and various departments to complete documentation, verify benefits, and

Qualifications

• Associate degree required; Bachelor's degree in Health Services Administration, Finance or healthcare related field preferred.
• 3–4 years of work experience in patient billing and/or insurance claim verification.
• 1–2 years experience with claims processing/reimbursement utilization review or case management preferred.
• Certified Transplant Financial Coordinator preferred; obtain within one year of hire.

Responsibilities

• In conjunction with medical staff develops letters of necessity, cost/benefit analyses, and information requirements of third party payors to help maximize reimbursement.
• Verifies insurance benefits and compensation charges by contacting insurers and employers to determine deposits, co-pays, and deductibles.
• Identifies payor needs and coordinates information to facilitate reimbursement; performs insurance verification for all third party payers.
• Obtains initial and subsequent pre-authorization for services and surgeries; re-verifies benefits and obtains authorization after treatment plan is established.
• Interviews candidates to determine insurance coverage and eligibility for programs to expedite payment for BMT services; ensures completion of documents to obtain reimbursement.
• Provide a treatment plan overview of covered and non-covered services as it relates to insurance coverage and/or self-pay responsibility.
• Maintains financial references including guidelines for reimbursement and payor-specific policies.
• Maintains contacts with agencies offering financial aid and develops processes for applicants.
• Assists patients with inquiries regarding financial/insurance issues and prepares individualized financial packets.

Skills

Interpersonal skills

Communication skills

Customer relations

Prioritization

Team player

Stress management

Problem solving

Education

Associate degree required

Bachelor's degree preferred

Job description

Georgetown University Hospital is seeking a Financial Coordinator for Bone Marrow and Stem Cell Transplant services to evaluate insurance coverage and assist in pre-authorization for transplant procedures. You will help ensure maximum reimbursement and guide patients to obtain resources for care, while coordinating cost-reduction opportunities and quality-improvement recommendations.

You will interact with medical staff and various departments to complete documentation, verify benefits, and