Transplant Financial Specialist

Overview

At Houston Methodist, the Transplant Financial Specialist position is responsible for ensuring that transplant patients will have adequate coverage for their transplant procedure. The Transplant Financial Specialist will provide education to the patient and their family regarding the financial clearance process.

Houston Methodist Standard

PATIENT AGE GROUP(S) AND POPULATION(S) SERVEDRefer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.

HOUSTON METHODIST EXPERIENCE EXPECTATIONS

• Provide personalized care and service by consistently demonstrating our I CARE values:
  • INTEGRITY: We are honest and ethical in all we say and do.
  • COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
  • ACCOUNTABILITY: We hold ourselves accountable for all our actions.
  • RESPECT: We treat every individual as a person of worth, dignity, and value.
  • EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

• Practices the Caring and Serving Model

• Delivers personalized service using HM Service Standards

• Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)

• Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience.

• Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job

• Displays cultural humility, diversity, equity and inclusion principles

• Actively supports the organization's vision, fulfills the mission and abides by the I CARE values

Responsibilities

PEOPLE ESSENTIAL FUNCTIONS

• Promotes a positive work environment and contributes to a dynamic team focused work unit that actively helps one another to achieve optimal departmental and organizational results.

• Consults with clinical transplantation staff, including coordinators and physicians, in order to facilitate the submission of required medical documentation to insurance carriers.

• Employs a high degree of professionalism and effectively engages with a diverse customer base, including patients/visitors, physician office staff, and representatives from internal departments and external organizations. Gives appropriate status updates.

SERVICE ESSENTIAL FUNCTIONS

• Meets with patients and/or family members to discuss benefit coverage and potential financial issues regarding the transplant process. Takes necessary steps to make certain arrangements/plans are made to meet financial requirements on a per case basis. Provides information regarding available resources.

• Consults with uninsured or underinsured patients and/or family members on resources for financial benefits.

• Contributes to departmental and hospital patient experience. Proactively seeks solutions to address patient and visitor issues and concerns. Alerts management in a timely manner to any unusual and/or difficult situations impacting the level of service.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Monitors and reports status of the financial clearance process and facilitates peer-to-peer and appeal processes.

• Continually monitors and reviews the transplant evaluation and admission account for accuracy so that services are paid or reimbursed appropriately. Updates electronic medical record with appropriate financial data, such as a bundled episode, as applicable. Takes appropriate follow-up action to resolve problems.

• Maintains log of patients referred for evaluation and of transplant financial clearance. Notifies coordinator and assists with obtaining reauthorization, if necessary, either at time of insurance change or expiration of authorization. When applicable, closes out the transplant episode and notifies appropriate parties that patient is no longer a transplant candidate.

FINANCE ESSENTIAL FUNCTIONS

• Works with hospital financial counseling to obtain and maintain single case agreements.

• Conducts benefit analysis and verification of patient's insurance coverage and obtains authorization for transplant related services.

• Creates and maintains transplant notification form (TNF).

• Utilizes resources effectively and efficiently, demonstrating responsible f