Specialty Transplant Billing Operator

Are you an experienced, passionate pioneer in technology who wants to work in a collaborative environment? As an experienced Specialty Transplant Billing Operator, you will have the ability to share new ideas and collaborate on projects as an Analyst without the extensive demands of travel. If so, consider an opportunity with Deloitte under our Project Delivery Talent Model. Project Delivery Model (PDM) is a talent model that is tailored specifically for long-term, onsite and/or remote client service delivery. Recruiting for this role ends on 11/30/2026

Work you'll do

As a Specialty Transplant Billing Operator / Billing and Claims Operator of Transplant Services you will be responsible for the accurate, timely billing, accounts receivable follow-up, and denial resolution of complex transplant accounts for a large health system. This role focuses on hands-on execution of hospital (facility) billing operations. Primary Responsibilities

• Prepare, review, and submit hospital (UB-04/837I) claims for transplant and related inpatient and outpatient services, ensuring coding, charges, and payer requirements are met before release.
• Work assigned A/R inventory through timely follow-up with commercial, Medicare, Medicaid, and managed care payers via portals, phone, and written correspondence.
• Research, analyze, and resolve denials and underpayments, including medical necessity, authorization, timely filing, and coding-related denials.
• Prepare and submit appeals with supporting clinical documentation, contract language, and payer policy references; track appeal status through resolution.
• Validate payer reimbursement against contract terms and flag variances, including transplant case rates, carve-outs, stop-loss, and outlier provisions.
• Verify that authorizations, referrals, and transplant-specific approvals (evaluation, listing, transplant, and follow-up phases) are on file and linked to the correct accounts.
• Coordinate with Patient Access, Coding, Health Information Management, Utilization Review, and the transplant clinical team to resolve documentation and account issues.
• Document all account activity clearly and completely in the billing system to support audit and handoff.
• Escalate payer trends, systemic denial root causes, and process gaps to leadership with supporting examples.

Transplant Specialty Responsibilities

• Bill and reconcile organ acquisition costs by transplant program (kidney, liver, heart, lung, pancreas, and others as applicable), including accurate use of organ acquisition cost center revenue codes and charge capture.
• Maintain organ acquisition cost center billing for Medicare, Medicaid, and commercial payers, including recovery of organ procurement organization (OPO) invoices and related acquisition charges.
• Support Medicare cost report reconciliation by tying organ acquisition billing, usable and non-usable organ counts, and acquisition charges to the general ledger and cost report worksheets.
• Partner with Reimbursement, Finance, and Decision Support to resolve variances between billed charges, payments received, and cost report data.
• Manage billing across transplant phases, including pre-transplant evaluation, listing, the transplant admission, and post-transplant follow-up, and apply payer-specific global or case-rate periods correctly.
• Identify and correct transplant-specific billing errors, including misapplied acquisition charges, duplicate billing of organ costs, and incorrect Medicare and Medicaid pass-through treatment.
• Apply payer-specific transplant policies, Centers of Excellence requirements, and contract provisions when billing and when disputing payments.
• Support payer and regulatory audits, cost report settlement activity, and data requests with accurate and timely account documentation.

A successful candidate would possess these skills:

• Ability to work independently and collaborate as part of a team
• Effective written and verbal communication skills
• Meticulous attention to detail and quality of work product
• Ability to build and sustain professional relationships
• Ability to lead projects or workstreams
• Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment
• Strong interpersonal skills and professional demeanor
• Ability to meet deadlines
• Ability to provide clear guidance to others

The team

AI & Engineering leverages cutting-edge engineering capabilities to build, deploy, and operate integrated/verticalized sector solutions in software, data, AI, network, and hybrid cloud infrastructure. These solutions are powered by engineering for business advantage, transforming mission-critical operations. We enable clients to stay ahead with the latest advancements by transforming engineering teams and modernizing technology & data platforms. Our delivery models are tailored to meet each client's unique requirements.

Our Industry Solutions offering provides verticalized solutions that transform how clients sell products, deliver services, generate growth, and execute mission-critical operations. We deliver integrated business expertise with scalable, repeatable technology solutions specifically engineered for each sector.

Qualifications

Required:

• 3+ years of hospital (facility) billing, claims follow-up, or denials management experience in an acute care or health system setting.
• 1 year of hands-on transplant billing, claims follow-up, or denials experience, including familiarity with transplant-specific payer requirements and global or case-rate billing periods.
• Working knowledge of UB-04/837I claim requirements, revenue codes, ICD-10-CM/PCS, CPT/HCPCS, and DRG-based and per diem reimbursement methodologies.
• Working knowledge of Medicare, Medicaid, and commercial payer rules, including timely filing, appeals, and authorization requirements.
• Proficiency with an enterprise patient accounting system (such as Epic Resolute, Cerner, or Meditech), payer portals, and Microsoft Excel.
• Bachelor's degree in information technology, business, healthcare, or a related field; or equivalent experience.
• Ability to travel 10%, on average, based on the work you do and the clients and industries/sectors you serve.
• Limited immigration sponsorship may be available.

Preferred Qualifications

• Direct experience billing organ acquisition costs and supporting Medicare cost report reconciliation (CMS-2552-10, Worksheet D-4 and related schedules).
• Familiarity with OPO invoicing, organ acquisition cost center structures, and Medicare and Medicaid transplant reimbursement rules.
• Experience with other complex or high-dollar specialty service lines, such as oncology, cardiology, orthopedics, or neurosciences.
• Experience with payer contract interpretation and underpayment recovery.

For individuals assigned and/or hired to work in a remote role, Deloitte is required by law to include a reasonable estimate of the compensation range for this role. This compensation range is specific to the remote role and takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $70,000 – $84,000.

Deloitte is committed to providing reasonable accommodations for people with disabilities. If you require a reasonable accommodation to participate in the recruiting process, please direct your inquiries to the Global Call Center (GCC) at USTalentCICInbox@deloitte.com.