Under the direction of the Transplant Finance Manager, the Transplant Financial Coordinator (TFC) is a designated member of the multidisciplinary transplant team. Incumbent is responsible for securing funding for transplant services, this includes: financial screening, insurance verification, submit authorizations, patient counseling for health plan coverage and development negotiation of payment or arrangements. Routinely confers with physicians, hospital administrators, contracting, payers and external agencies to develop and coordinate complex negotiations for reimbursement payment rates.

Responsible for activities which include compiling patient profiles for substantiation of patient's medical condition to justify specialized services. Produces monthly reports for administrative and clinical leaders responsible for specific programs. Monitors and tracks accounts to ensure that payers and patients have complied with established agreements. Works closely with transplant staff to educate members of contact specifics for individual patients. Involves patient, third party, government, physician billing and/or collections activities. Provides for coordinated processes, procedures and systems, customer service delivery models and ensuring compliance with internal policy and external agency regulations. Advocate for your patients by ensuring they receive all the benefits they are entitled to and by helping them navigate the complexities of their insurance plans.

Manages insurance reimbursement from third-party billings and government insurance programs. Keeps abreast of the full array of third-party contracts and billing/collections requirements. Incorporates cash posting, accounts receivable management and financial counseling for securing collections of accounts. Investigates highly complex claims, evaluate alternative funding sources for patients in need, and propose procedures and systems in support of efficient workflows and maximization of reimbursement.

• Bachelor's Degree in business, healthcare administration or related area; and/or equivalent experience.
• A minimum of three (3+) or more years of relevant experience.
• Demonstrated knowledge of medical terminology and coding.
• Experience and proven success in billing and/or collections processes, concepts, systems and external regulations.
• Working knowledge of healthcare and insurance authorization process and willing to train motivated candidate to the field of transplant finance.
• Working knowledge of health plans with special processing requirements for emergency patients and ability to effectively communicate these requirements to physicians and administrative personnel under time urgent conditions.
• Working knowledge of State and Federal programs to ensure reimbursement from Medicare, Medi-Cal, CCS programs, out-of-state Medicaid, or other sponsoring agencies.
• Must have excellent telephone etiquette and ability to work with a diverse interdisciplinary team.
• Strong knowledge of billing and / or collections processes, concepts, systems and external regulations. Knowledge of medical terminology and coding.
• Strong knowledge of the regulations and confidentiality issues involved in the revenue side of medical care, including private and government insurance, self-pay, collections, and reporting and data management.
• Strong analytical skills to produce comprehensive reports, and identify trends and variations.
• Strong interpersonal and customer service skills to work effectively with all parties.
• Strong ability to provide recommendations on issues of functionality and operations in billing. Ability to serve as a resource, providing expertise and education to staff and management at all levels.
• Strong computer proficiency in all relevant hardware and software, with a knowledge of spreadsheet (Excel) and accounting applications, and a variety of specialized billing and insurance systems.

• Previous experience working in transplant to include: Transplant finance experience.
• Previous experience working in the healthcare insurance industry.

• Must be able to work various hours and locations based on business needs.
• Employment is subject to a criminal background check and pre-employment physical.