Transplant Financial Coordinator

Overview

Transplant Financial Coordinator

40 hours per week, day shift

JOB SUMMARY:  Under general supervision, performs departmental administrative duties and assists the department head with daily activities and special projects. Directs and coordinates the work of other employees in the absence of the department head, and provides authoritative information to a variety of sources throughout the Medical Center. The coordinator will work with patients and their families beginning with the referral for the transplantation and continuing through and after transplantation in a compassionate and tactful manner in order to help facilities access to and provide continuity of care. The transplant financial coordinator works with other members of the transplant team, specialty pharmacy, insurers, and administrative personnel to coordinate and clarify the financial aspects of the patient's care before, during, and after the transplant.

EDUCATION/EXPERIENCE: Associate's degree and three years’ experience in transplant, insurance, revenue cycle, financial counseling or customer service; or, an equivalent combination of education and experience. Experience working with transplant patients preferred.  

LICENSURE, CERTIFICATION, and/or REGISTRATION: Certified Transplant Financial Coordinator preferred. Required within two years of hire date.  

ESSENTIAL FUNCTIONS:

1. Obtains detailed patient insurance benefit insurance for all aspects for the transplant processes, including but not limited to outpatient drugs, specialty pharmacy drugs, follow up clinic visits, travel and housing if necessary.
2. Discusses benefits and other transplant financial issues with patients and/or family members during the initial evaluation.
3. Advises patients on insurance and billing issues and options. Serves as a resource for patients and their family members on financial matters. Frequent contact with the patient throughout the transplant process.
4. Obtains all necessary payor authorizations. Verifies transplant coverage and other medical benefits and acquires necessary referrals and authorizations.
5. Communicates appropriately to transplant coordinator and transplant social services regarding potential approval of patients.
6. Assist with inpatient and outpatient admissions and financial clearances to ensure smooth admission to facilities.
7. Assist in the creation of new accounts for patients within the system/transplantation database by entering demographics and financial information.
8. Monitors and updates information regarding insurance data, physician authorizations and preferred providers and documents data and provide reports as needed.
9. Works with reimbursement department and patient billing department to “flag” transplant patient accounts for cost reporting purposes
10. Work in conjunction with and trains clinic receptionist/clerk to obtain preauthorization numbers for outpatient visits/procedures. Coordinates with PFS Business Office for co-pay collection. Follows up with Patient Financial Services the process of patient billing and reimbursement under direction of the transplant manager..  Educates Patient Financial Services on different types of payors related to the surgical procedure
11. Attends patient selection multidisciplinary conferences to provide update regarding financial clearance on patients to be listed on currently are on the listed awaiting organ transplantation.
12. Interfaces with and coordinates efforts of admissions, business office, medical records, pharmacy, financial services, social services, and risk management as it relates to the transplant intake function and financial clearances.
13. Consults with and provides information as requested to managed care organizations. Releases copy of patients’ medical records to insurance carriers, referring MDs, and dialysis units as appropriate, when patients are listed on the UNOS waiting list.
14. Performs other duties as assigned.

SKILLS & QUALIFICATIONS:

• Detailed knowledge of financial matters and hospital billing
• Strong mathematical skills
• Knowledge of personal computers, peripheral devices, PCS software application
• Strong spreadsheet applications and word processing skills
• Strong interpersonal skills, including the ability to work with very ill patients
• Ability to work with Web-based programs to review insurance eligibility and benefits

WORK ENVIRONMENT:

• Clinical and office environment
• Regular exposure to the risk of blood-borne diseases, infectious, and contagious diseases
• Contact with patients, family members, visitors, co-workers, and medical staff under a wide variety of circumstances.
• Subject to multiple interruptions
• Requires working under stressful conditions with providers and patients
• Handles complaints, settles disputes, and resolves grievances and conflicts
• Occasionally works irregular hours
• Subject to highly stressful, crowded conditions