Transplant Financial Specialist

Houston, Texas
Houston Methodist Hospital

JOB SUMMARY

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.

PRIMARY JOB RESPONSIBILITIES

Job responsibilities labeled EF capture those duties that are essential functions of the job.

PEOPLE – 15%

1. 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. (EF)
2. Consults with clinical transplantation staff, including coordinators and physicians, in order to facilitate the submission of required medical documentation to insurance carriers. (EF)
3. 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. (EF)

SERVICE – 20%

1. 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. (EF)
2. Consults with uninsured or underinsured patients and/or family members on resources for financial benefits. (EF)
3. 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. (EF)

QUALITY/SAFETY – 25%

1. Monitors and reports status of the financial clearance process and facilitates peer-to-peer and appeal processes. (EF)
2. 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. (EF)
3. 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. (EF)

FINANCE – 30%

1. Works with hospital financial counseling to obtain and maintain single case agreements. (EF)
2. Conducts benefit analysis and verification of patient’s insurance coverage and obtains authorization for transplant related services. (EF)
3. Creates and maintains transplant notification form (TNF). (EF)
4. Utilizes resources effectively and efficiently, demonstrating responsible financial stewardship. Manages own time effectively and prioritizes work to achieve maximum results in a timely manner. (EF)

GROWTH/INNOVATION – 10%

1. Displays initiative to improve job functions. Demonstrates adaptability and flexibility during changing demands. Offers suggestions to streamline process for efficient patient flow. (EF)
2. Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development. (EF)

This job description is not intended to be all inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

EDUCATION REQUIREMENTS

o Associate’s degree required or additional two years of experience (in addition to the minimum experience requirements listed below) required in lieu of degree

EXPERIENCE REQUIREMENTS

o Three years of experience in a hospital business office or related financial setting

CERTIFICATIONS, LICENSES AND REGISTRATIONS REQUIRED

o None

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

o Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations

o Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security

o Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles

o Strong verbal and written communication and interpersonal skills to interact effectively with patients, patients’ representatives, third-party payers, and colleagues with varying professional backgrounds in the resolution of reimbursement for transplant services

o Knowledge of payer requirements, authorizations, and insurance terminology

o Proficient understanding of medical terminology and diagnosis/procedural codes

o Comprehensive knowledge of state and federal regulations relevant to role

o Ability to analyze and solve problems

o Well-developed organizational skills with ability to multi-task and utilize time efficiently

o Ability to adapt to changes in the work environment and modify approaches or methods to best fit the patient’s situation

o Ability to remain calm in stressful situations with patience and understanding

o Proficient computer skills in Microsoft Word and Excel and ability to learn and navigate multiple software programs and payer websites

o Ability to handle detail work accurately and rapidly

o Bilingual skills (English/Spanish) preferred

SUPPLEMENTAL REQUIREMENTS

Work Attire Yes/No

Uniform No

Scrubs No

Business professional Yes

Other (dept approved) No

On-Call Yes, as required by entity/department for operational need

Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Event, etc) regardless of selection above.

Travel

May require travel within No

Houston Metropolitan area

May require travel outside No

of Houston Metropolitan area

Travel specifications may vary by department.

Please note any other special considerations to this job:

Company Profile:

Since its founding in 1919, Houston Methodist Hospital has earned worldwide recognition. Houston Methodist Hospital is affiliated with the Weill Medical College of Cornell University and New York-Presbyterian Hospital, one of the nation’s leading centers for medical education and research. In 2022, U.S. News & World Report named Houston Methodist Hospital to its prestigious Honor Roll for the sixth time. Also, in this year’s rankings, Houston Methodist Hospital was named the No. 1 hospital in Texas for the 11th year in a row. Houston Methodist Hospital directs millions of research dollars into patient care and offers the latest innovations in medical, surgical and diagnostic techniques. With 946 operating beds, 85 operating rooms and nearly 8,500 employees, Houston Methodist Hospital offers complete care for patients from around the world.