Position Description

Manages databases for tracking and control of patient account billing, follow up and payment for global transplant payors. Collects and maintains financial data; provides reports. Provides and assists in evaluation of quality assurance data for department processes. Performs global account follow up with third party administrator. Processes global payments, allocates cash received to appropriate patient accounts, and determines when global case is paid out under contract. Performs patient account management needed for administration of global contracts. Obtains transplant benefit information and insurance prior approval for selected group of patients.

 

PRIMARY DUTIES AND RESPONSIBILITIES

Coordinates database functions for global billing and works closely with business office to ensure timely and correct billing of all global patient claims. Coordinates database functions for global and non-global follow up for patient accounts, including non-global work list for business office collections, and global case list for global collections by BMT Business Operations. Ensures accuracy of global accounts receivable reports. Performs follow up with third party administrator to ensure timely collection of global payments. Performs patient account and referral list review to ensure that all global payor accounts are captured in the database for billing, collection, data collection and management. Monitors financial class changes, bill holds, and records global period dates within database. Reviews patient list for duplicate medical record numbers in financial system. Identifies patient account in the financial system as global or non-global for all financial class Q accounts. Generates standard weekly, monthly, quarterly and yearly reports from multiple databases, performing additional analysis as necessary. Performs maintenance, backup and quality checks for data. Analyzes data requests from managed care team, oncology, transplant, business office, and other departments as appropriate, generating all necessary reports and performing additional analysis as necessary. Collects and compiles financial data; prepares detail summary reports for submission to appropriate departments and task forces. Manages registry invoice database; carries out activities associated with registry payment and hospital charging. Works with  business office transplant staff; acts as a resource in the interpretation of all applicable contracts and for the billing, follow up, account adjustment, and account tracking process used in the business office. Provides phone support, QI, and training as needed. Handles split bill referrals from TPA, refund request approvals, and late charges including lab send-out invoices. Reconciles and processes payments from the third party administrator for global transplant accounts. Maintains individual global case records and determines that case is paid according to global contract. Works with TPA to provide patient list for data analysis. Reviews patient population in order to coordinate timely account opening and closing to correspond to global periods. Assists with patient billing questions. Obtains transplant insurance prior approvals and meets with patients for transplant insurance coverage review for selected group of patients. Assists with other duties as needed.

Position Requirements

KNOWLEDGE SKILLS AND ABILITIES/LICENSE OR CERTIFICATION REQUIRED

Two years college, an associate degree or Healthcare financial services experience (4-6 years) Strong organizational skills and ability to work independently. Knowledge of and experience in the utilization of word processing, spreadsheet, database, and graphic presentation computer applications.

Service Area Overview