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Company: MedStar Medical Group
Location: Washington, DC
Career Level: Entry Level
Industries: Not specified
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Description

General Summary of Position
Evaluates financial status, insurance/ compensation coverage and resources of Medical System Transplant candidates and patients. Serves as key resource in assuring the maximum reimbursement to the institution for required services, and in assisting transplant patients to obtain the resources to assure the standard of care necessary to maximize transplant success. Coordinates the opportunities for reduction of costs and makes recommendations for continuous quality improvement initiatives. These functions are performed in accordance with all applicable laws and regulations and Georgetown University Hospital's philosophy, policies, procedures and standards.


Primary Duties and Responsibilities

  • In conjunction with medical staff, develops letters of necessity, cost/benefit analysis and information requirements of third-party payors to help assure maximum consideration for reimbursement. Participates actively in education and outreach programs to insurance companies to affect positive responses to requests for reimbursement (20%).
  • Verifies insurance benefits and compensation coverages by contacting insurance companies and employers to determine the necessity for advance deposits, co-payments, and deductibles. Identifies payor needs and information deficits, and coordinates the provision of information to facilitate reimbursement (20%).
  • Interviews candidates to determine their insurance coverages and potential eligibility for insurances/programs to expedite payment for Transplant services; ensures the completion of appropriate documents to assist in obtaining reimbursement. (20%)
  • Develops and maintains financial references, including guidelines for reimbursement, state and federal regulations, and payor-specific reimbursement policies. Develops and maintains GUH Transplant Reimbursement policies, procedures, and resource material references. Updates third-party payor reimbursement needs.
  • Develops and updates resource lists for assisting patients with insurance choices, including COBRA, Social Security disability, retirement, and new employment. (10%)
  • Establishes and maintains regular contacts with agencies offering financial aid; develops
  • efficient processes/procedures for candidates to follow to complete the application process. Facilitates efficient communications for timely responses.
  • Maintains continuous contact with GUMC departments (e.g. Admitting, Utilization Review, Social Work, Patient Financial Services) to assure that the proper pre-admission and pre-certification requirements are followed. (10%)
  • Participates in Transplant Team meetings; presents financial considerations at evaluations; communicates financial reimbursement policy needs and issues to the team; communicates with GUH administration as appropriate.
  • Works with the Transplant Team to develop and initiate new financial reimbursement programs and services. Assists with assessment of financial reimbursement requirements of new programs, gathering data, and communicating with both the Transplant Team and various GUH departments. (7%).
  • Assists patients with inquiries regarding financial/insurance issues through data collection, assessment, and follow-up activities. Identifies appropriate resources to handle problems and complaints effectively. (5%)
  • Utilizes Patient Management Information System (PMAS) to initialize and update pertinent insurance/guarantor information, obtain billing and payment information after discharge, and communicate to other PMAS users, necessary information. (5%)
  • Develops computerized database reports specific to Transplant patients, including pertinent data, such as cost, utilization review (LOS), complications, and reimbursement amounts.
  • Prepares and presents individualized financial packets for candidates and explains all aspects to candidates so it is understandable. Updates and maintains the respective file/record throughout the patient's involvement with GUMC. (2%)
  • Monitors monthly acquisition billing reports and assist with donor and recipient acquisition claims. (1%)
  • Exemplifies Guest and Staff Relations standards in all activities.
  • Assumes other duties and responsibilities that are appropriate to the position and area. The above responsibilities are a general description of the level and nature of the work assigned to this classification and are not to be considered as all-inclusive.
    • CUSTOM.PRIMARY.DUTIES.RESPONSIBILITIES.ADDENDUM


     

    Minimum Qualifications
    Education

    • Bachelor's degree - A baccalaureate degree in Health Services Administration, Finance, or a healthcare related field is required

    Experience

    • 3-5 to years' work experience in patient billing and/or insurance claim verification required
    • Experience with claim processing / reimbursement, utilization review, or case management preferred

    Knowledge, Skills, and Abilities

    • Excellent interpersonal & communication skills.
    • High level of competence in customer relations in a professional environment.
    • Ability to prioritize, organize work and be self-directed.
    • Ability to work as a member of a team.
    • Ability to work in stressful situations.
    • Good problem-solving skills.


    This position has a hiring range of $58,656 - $98,384

     


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