Transplant Financial Rev Rep

About Us

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

Our Core Values are:

• We serve faithfully by doing what's right with a joyful heart.
• We never settle by constantly striving for better.
• We are in it together by supporting one another and those we serve.
• We make an impact by taking initiative and delivering exceptional experience.

Benefits

Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level.

Job Summary

The Transplant Financial Review Representative verifies coverage and medical benefits. They acquire necessary referrals and authorizations for services. Submits medical records to insurance companies for prior authorizations. Monitors transplant patients to update insurance documentation, physicians, authorizations, and providers. Close communication is required with patients, insurance companies, and physicians.

Essential Functions of the Role

• Conducts high volume of pre-certification authorizations for all transplant service lines.
• Obtains required PCP referrals for all transplant services lines, as applicable.
• Monitors transplant patients through all phases to update insurance data, attending physicians, authorizations, and other providers, as applicable.
• Ensures transplant patient accounts are registered in compliance with Transplant Managed Care contractual guidelines.
• Assists patients with questions about insurance and financial issues. Consults with patients on insurance options to help them get the best coverage.
• Works within Electronic Medical Record to clear transplant account work queues. Establishes correct authorization coding/billing accounts. Creates Transplant Guarantors/Transplant Flag when patients transition between general services and transplant. Records authorization of services.
• Assists with annual reverification in January of each year of transplant coverage for all patients pre-transplant through one year post-transplant.
• Answers department office number to assist with patient, provider, and insurance company questions related to transplant services.

Belonging Statement

We believe that all people should feel welcomed, valued and supported.

QUALIFICATIONS

• EDUCATION - H.S. Diploma/GED Equivalent
• EXPERIENCE - Less than 1 Year of Experience