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Under general supervision and following established practices, policies, and guidelines:

1. Analyze denied reimbursement transplant recipient/donor claims.
2. Monitor, evaluate and review CSMC Managed Care Transplant contracts and reconcile to payments received.
3. Ensure appropriate insurance coverage and successfully collect underpayments from insurance carriers.
4. Coordinate with Transplant Financial Coordinators and insurance companies to resolve payment variances.
5. Accurately and consistently document the results of all audits and subsequent adjustments in the hospital information system.
6. Prepare transplant packaged reports.
7. Identify systemic payment errors and make process improvement recommendations to assure highest revenue recovery possible.
8. Reconciles all hospital encounters within Solid Organ/BMT Transplant global case rate.

Experience:

• Five (5) years' experience in hospital billing and collections experience

Educational Requirements:

• High School Diploma/GED required.
• Associate Degree/College Diploma- preferred.