UW Medicine’s mission is to improve the health of the public by advancing medical knowledge, providing outstanding primary and specialty care to the people of the region, and preparing tomorrow’s physicians, scientists and other health professionals. UW Medicine owns or operates Harborview Medical Center, Northwest Hospital & Medical Center, Valley Medical Center, and UW Medical Center, a network of UW Medicine Neighborhood Clinics that provide primary care, UW Physicians, UW School of Medicine, Airlift Northwest, and other owned, operated or affiliated entities as appropriate. In addition, UW Medicine shares in the ownership and governance of Children’s University Medical Group and Seattle Cancer Care Alliance a partnership among UW Medicine, Fred Hutchinson Cancer Research, and Seattle Children’s.

UW Medicine Financial Access Clearance Team Services Department (FACT): This is a hybrid position with both on site in clinic and remote telework days. The Financial Access Specialist 1 (FAS 1) is available for UWMC Transplant Specialty Services.

Under general supervision, the Financial Access Specialist for Transplant Specialty Services is responsible for interviewing potential transplant recipients to fully assess the patients’ insurance coverage and obtain financial clearance to begin the transplant work up. The position serves as a liaison between the hospitals, patient and third party payers for all financial matters and secures necessary authorizations to ensure transplant related services are approved before proceeding with treatment. The Financial Coordinator educates patients regarding their insurance coverage, and advises them of any financial responsibility they may have. Active participation is required in department staff meetings, selection meetings and huddles. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:

Obtaining detailed patient insurance benefit information for all aspects of the transplant process, including, but not limited to, outpatient prescription drugs, organ acquisition, follow-up Clinic visits, and travel and housing if necessary. Document patient’s eligibility and benefits in Max and in Epic Transplant Guarantor account.
One-on-one interviewing over the phone and/or in person to interpret benefits and other transplant financial information with patients and/or family members during initial evaluation. Advising patients on insurance and billing issues and options. Serving as a resource for patients and their family members on financial matters.
Identifying and effectively communicating financial information to transplant team members,
Patients and their families with emphasis on identifying any potential patient out-of-pocket

Liability.

Monitoring and updating information regarding insurance data, physicians, authorizations, and preferred providers.
Obtaining all necessary payer authorizations. Verifying transplant coverage and other medical benefits and acquiring necessary referrals and authorizations. When necessary request single case agreement with non-contracted health plans through UW Medicine Contracting Department.
Complete Inpatient admission notification for urgent or planned admissions. Coordinate with the Utilization Management department to facilitate patient admission/discharge information to fulfill insurance carrier requirements.
Communicate with appropriate clinical staff the status of ongoing payer requests and the need for additional information in order to facilitate completion of all payer requirements; Notify appropriate persons of denials and/or potential denials for non-covered services and other problems; initiate communication to appropriate agencies and to hospital staff for appeal of denials; Conduct necessary follow up on all initiated prior authorizations at pre-determined intervals in an effort to obtain the final authorization number i.e. insurance approval
Establishes and maintains a working relationship with key contacts at insurance companies (i.e. case managers, medical directors) and other departments in UWMC (i.e. Patient Financial Services, IECS (Insurance Eligibility & Counselling Services), Contracting …….etc) Attends and participates in transplant team meetings including Selection Meeting and; or huddles
Maintains current knowledge of Medicare and Medicaid rules or any legislation affecting the transplant patients. Continually networks with other FAS 2 in Transplant Specialty Services and  Transplant Financial Coordinators, organizations, and centers to expand knowledge and understanding of the transplant process.
Collaborate with clinical team, contracting, and financial counseling staff to communicate changes in pre-authorization, denial, medical review, appeals, managed care contracts, and referrals to ensure timely process of financial clearances to avoid high dollar denials.
Communicate effectively to maintain positive working relationship with all departments, including, providers, nurses, and staff.
Attend Transplant selection committee meeting and ready to present and discuss financial issues on patients that are being presented for transplant listing and surgeries.
Responsible to participates in departmental, transplant selection committee, task forces/meetings as required.
Perform the duties as a back-up financial counselor to assist staff with their work load, if float or additional staff is unable to assist staff with additional work.
Complete all other job duties as assigned by direct management.

Minimum Qualifications:

High School diploma or GED certificate plus two years of experience in a medial office setting; OR, equivalent education/experience.