Transplant Financial Coordinator

Rochester, NY

POSITION SUMMARY:

The Transplant Financial Coordinator (TFC) staff is part of a multidisciplinary team charged with the responsibility of providing accurate, financial clearance, and patient financial account management for all VAD, Solid Organ and Bone Marrow Transplant, and CAR-T Therapy related to inpatient and outpatient services. The TFCs follow the patients through their course of treatment to ensure payment for the service/transplant as well as coverage for the necessary immunosuppressant medications and equipment post-transplant. The TFCs are responsible for the analysis, validation and regulatory and compliance activities associated with the financial clearance process. The TFCs mitigate the financial risk to URMC by performing an accurate financial clearance review along with a comprehensive analysis of patient and payor specific benefits and patient liability. If the patient has no means to pay, the TFCs refer to Financial Case Management to assist the patient/family in the Medicaid, Child Health Plus, or NYS Marketplace Exchange process.

This role may have the option to work a hybrid-remote schedule and communicate daily through virtual meetings.

SUPERVISION AND DIRECTION EXERCISED :

Responsible for monitoring own performance on assigned tasks, Self-directed, must make complex decisions independently, May train and coordinate activities of peers or other staff as assigned by management.

MACHINES AND EQUIPMENT USED :

Standard office equipment, including but not limited to: telephone, page system, pneumatic tube system, personal computers, printer, photo copier, fax, RightFax, EPIC, Outlook, and electronic third party payer systems.

ESSENTIAL DUTIES :

Customer Interactions - 20%

Meets with all transplant candidates at clinic site utilizing professional and excellent communication skills to obtain demographic information, explain their transplant insurance benefits and limits, inform patients of the anticipated costs of transplant services, the anticipated patient liability, and the patient responsibilities (e.g. post-transplant medications), explain donor billing policies, discuss financial options, and obtains all required signatures for payment of hospital services.

Process New Referrals for Evaluation - 25%

  • Analyze, organize, and utilize complex data and rules related to contracting and patient benefits to provide financial clearance

  • Interact with Transplant Clinical teams to obtain treatment plans and discharge planning in order to begin the insurance verification process

  • Interact with Clinical teams prior to patient’s financial clearance to provide key information and data regarding benefits, support and patient financial liability

  • Prepare financial packets based on each individual patient’s benefits, financial interview, and calculated estimated expenses

  • Share financial screen daily/weekly with the clinical teams at each of their respective meetings

  • Notify the patient if not financially approved for evaluation at URMC

  • Council patients on changing to an insurance that we participate with, ensuring the best coverage for both patient and reimbursement.

  • Maintain updated knowledge of hospital contract for in and out-of-network payers.

Data Maintenance and Billing Management - 35%

  • Obtain transplant benefits and precertification along with all other billing requirements.

  • Identify non-covered hospital services, inquire how the financial obligation will be met, analyze patient’s financial status and advise patient on the best course of action for payment of transplant and transplant drugs.

  • Work with Financial Case Managers on patients with a Medicaid Spend Down case, providing the FCM with medical bills that can be counted toward a spend-down.

  • Serve as a resource to transplant candidates with respect to alternate choices of insurance coverage.

  • Perform crisis intervention when financial issues arise pre and post-transplant.

  • Resolve Medicare post-transplant prescription coverage issues with Social Security Administration for reinstatement of benefits.

  • Work with the Financial Case Manager to identify financial alternatives if insurance does not cover a necessary service.

  • Responsible for referring cases to Financial Case Management, when other insurance can not be secured, to explain the Medicaid guidelines/process and provide information regarding the Financial Assistance protocol.

  • Assist patients and family with insurance questions and resolution of billing issues.

  • Process clinical information required by third party payers in a timely manner.

  • Ensure that payer’s precertification requirements are met and patients are in the right status and work with the payers to ensure that the documentation supports the transplant services provided to make certain the hospital and physicians will be paid.

  • Maintains weekly status of all pending cases and takes appropriate action to resolve them.

  • Works collaboratively with clinical team on authorization denials and inquires on appeal process with the insurance payer.

  • Reviews, analyze and act upon third party COB discrepancies prior to billing.

  • Sets up visits in EPIC for anonymous donors who come to SMH for their donation.

  • Participates in transplant review committee to discuss financial barriers and when necessary, negotiations of single case agreements.

  • Alerts the Transplant team of any issues that may impact patient’s ability to undergo transplant.

  • Updates EPIC and the Transplant Questionnaire with regards to financial and insurance information on all potential candidates and transplant recipients.

  • Identifies global/bundled billing episode, period in which it is valid, and notifies appropriate URMC parties.

  • Creates Transplant and Donor guarantors with accompanied bundled episodes.

Case Management (Transplant) - 15%

  • Maintains a caseload of approximately 600 patients on the wait list and maintains their case files in accordance with current state, federal and agency rules.

  • Process approximately 1,100 referrals annually to financially screen as potential candidates.

  • Sets the next review date by adding a duplicate Transplant Surgery Checklist item to trigger the next period for financial verification.

  • Requests updates to the effective and termination dates of the transplant approval when expired.

  • Monitors patients to ensure they apply for Medicare timely, by the end of the 30-month coordination period.

  • Reviews the top 10 liver patients by blood types and updates the liver database with insurance and authorization timeframe.

  • Responsible for re-approvals when patient are approaching transplant approval expiration.

Attend meetings and Continuing Education - 5%

  • Attends weekly selection committee meetings.

  • Attends quarterly billing meetings to discuss pharmacy, insurance coverage and/or billing problems.

  • Attends the annual educational Transplant Financial Conference.

  • May train other staff as assigned by management.

QUALIFICATIONS :

AAS degree and 3 years of related experience such as knowledge of insurance verification, authorization, or billing experience required or an equivalent combination of education and experience. Extensive knowledge and comprehension of ICD-10 and CPT coding, medical terminology, and insurance standards and regulations. Requires a high degree of professionalism and motivation with excellent written and verbal communication and customer service skills; ability to work independently as well as in a team environment; highly collaborative; self-starter; strong computer skills and ability to type 45 words per minute. Flexible to be on call and work other assigned hours, weekends and/or responsibilities as needed.

Licensure, and/or Certification: Position may be subject to membership with the Transplant Financial Coordinators Association and may be subject to certification with TFCA.

NOTE : This document describes typical duties and responsibilities and is not intended to limit management from assigning other work as required.

The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion to advance the University’s mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled

Pay Range

Pay Range: $19.00 - $24.70 Hourly

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job’s compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

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