Department:

37822 Carolinas Medical Center - Pre Transplant Center

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

Monday- Friday 8am-430pm; with some early days for organ selection. Hybrid schedule with 2 required days on site. Call for after hours

Pay Range

$22.90 - $34.35

Major Responsibilities

Obtain detailed patient insurance benefits for all transplant-related aspects, including outpatient drugs, specialty pharmacy drugs, follow-up clinic visits, travel, and housing. Review, monitor, and research insurance benefits and potential patient financial needs; discuss findings with patients and families; report to the transplant selection committee. Advise patients on insurance and billing issues; serve as a financial resource for patients and their families throughout the transplant process. Develop resolutions for potential patient financial out-of-pocket exposure; assist patients in planning and overcoming financial obstacles. Obtain necessary payor authorizations; verify transplant coverage and other medical benefits; acquire referrals and authorizations. Consult with clinical transplantation staff, including coordinators and physicians, to facilitate the submission of required medical documentation to insurance carriers; monitor and report the status of the financial clearance process. Communicate with transplant coordinators and social workers regarding patient approval status. Assist with inpatient and outpatient admissions and financial clearances to ensure smooth facility admissions. Create new patient accounts in the system/transplantation database by entering demographics and financial information. Monitor and update insurance data, physician authorizations, and preferred providers; document and provide updates. Work with the reimbursement and patient billing departments to flag transplant patient accounts for cost reporting. Collaborate with the contracting department to establish single case agreements when necessary; follow up on these payors and assist in contracting efforts. Attend patient multidisciplinary conferences to provide updates on financial clearance for patients awaiting organ transplantation. Coordinate efforts with admissions, business office, medical records, pharmacy, financial services, social services, and risk management for transplant intake and financial clearances. Consult with managed care organizations and release patient medical records to insurance carriers, referring providers, and dialysis units as appropriate. Collaborate with Finance and Managed Health Resources staff to ensure proper billing under global contracts/Center of Excellence agreements. Resolve conflicts involving authorization and reimbursement challenges. Participate in on-call coverage for insurance verification for incoming transplant patients as required.

MINIMUM JOB REQUIREMENTS

Education

High School Diploma/GED with 3 years of insurance related experience or associate's degree and 1 year of insurance related experience orbachelor's degree in related field

Certification / Registration / License

n/a

Work Experience

High School Diploma/GED with 3 years of insurance related experience or associate's degree and 1 year of insurance related experience orBachelor's degree in related field

PHYSICAL REQUIREMENTS AND WORKING CONDITIONS

Work is primarily sedentary in nature; no special demands are required.The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

PREFERRED JOB REQUIREMENTS

Education

Bachelor's Degree

Certification / Registration / License

CFTC Certification

Work Experience

Transplant insurance experience

DISCLAIMER

All responsibilities and requirements are subject to possible modification to reasonably accommodate individuals with disabilities.

This job description in no way states or implies that these are the only responsibilities to be performed by an employee occupying this job or position. Employees must follow any other job-related instructions and perform any other job-related duties requested by their leaders.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or trainingPremium pay such as shift, on call, and more based on a teammate's jobIncentive pay for select positionsOpportunity for annual increases based on performance

Benefits and more

Paid Time Off programsHealth and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term DisabilityFlexible Spending Accounts for eligible health care and dependent care expensesFamily benefits such as adoption assistance and paid parental leaveDefined contribution retirement plans with employer match and other financial wellness programsEducational Assistance Program

About Advocate Health 

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.