Patient Financial Counselor - Military Veterans

Performs coordination, monitoring, maintenance, updating of the Revenue Cycle?s Transplant cases in order to optimize gross and net revenue and ensure compliance with third party payer contracts and billing requirements. Ensures timely review of contract updates guidelines and implements necessary changes affecting the specialty billing team and proposes process improvements. Works closely with the clinical and administrative staff in specialty billing areas to ensure all patient accounts are handled in accordance with approved processes. Position works closely with the staff in various Clinical Departments, Patient Financial Services, Registration, Integrated Payment Posting, Contracting, and Payors. Position ensures timely and accurate billing and collection of all Transplant cases claims/packages in accordance with established policies for both Hospital billings and Professional Billings.

• Perform post-transplant billing counseling services to patients including, discussion of benefits, financial concerns. Confirm patient insurance coverage, obtain, verify, and update insurance, financial, statistical and demographic information.
• Monitor incoming patient accounts ensuring accuracy in billing, collections, and payment processing.
• Prepare Billing Packages and ensure claim submission
• Investigate complex reimbursement issues pursuing appropriate actions to include statusing, adjustments, refunds, transfers, and billing third party payers.
• Pursue collections of outstanding accounts ensuring not only that appropriate actions and decisions are made on the aged accounts but that all accounts are resolved.
• Initiate adjustments, write-offs within established guidelines.
• Assist Credit Balance team to ensure appropriate refunding transactions connected to multiple payment accounts.
• Respond to complex financial questions regarding patient accounts. Answer inquiries and resolve problems for patients, staff and payors including resolutions of disputed billings, liability transfers, and system programming issues.
• Review changes made to transplant contracts, provide input to Contracting regarding operational, reimbursement and collection concerns.
• Review of all regulatory and third-party payer billing requirements to assess their impact on the transplant team activities and ensure such issues are disseminated to the appropriate hospital personnel. Coordinates with Patient Financial Services, HIM/Coding Department?s, Transplant Clinic staff, and other internal customers to ensure that the billing is accurate and in compliance with regulatory and/or contractual guidelines.
• Assist with development of analytical reporting to streamline data for use by internal and external customers.
• Suggest and assist with implementation of reporting and other mechanisms to ensure efficiency and accuracy in the revenue cycle processes.
• Assist in the development/revision of team policies and procedures.
• Serve as a resource to various internal departments, external payers regarding complex reimbursement issues and related operational issues.
• Establish and maintain positive working relationships with department administrators, revenue cycle staff, payors and all other customers.