Transplant Financial Coordinator

Department: 37822 Carolinas Medical Center - Pre Transplant Center

Status: Full time

Benefits Eligible: Yes

Hours Per Week: 40

Schedule Details/Additional Information:

Monday
- Friday 8am-430pm; with some early days for organ selection. Hybrid schedule with 2 required days on site. Call for after hours

Pay Range

$22.90 - $34.35

• Obtain detailed patient insurance benefits for all transplant-related aspects, including outpatient drugs, specialty pharmacy drugs, follow-up clinic visits, travel, and housing.
• Review, monitor, and research insurance benefits and potential patient financial needs; discuss findings with patients and families; report to the transplant selection committee.
• Advise patients on insurance and billing issues; serve as a financial resource for patients and their families throughout the transplant process.
• Develop resolutions for potential patient financial out-of-pocket exposure; assist patients in planning and overcoming financial obstacles.
• Obtain necessary payor authorizations; verify transplant coverage and other medical benefits; acquire referrals and authorizations.
• Consult with clinical transplantation staff, including coordinators and physicians, to facilitate the submission of required medical documentation to insurance carriers; monitor and report the status of the financial clearance process.
• Communicate with transplant coordinators and social workers regarding patient approval status.
• Assist with inpatient and outpatient admissions and financial clearances to ensure smooth facility admissions.
• Create new patient accounts in the system/transplantation database by entering demographics and financial information.
• Monitor and update insurance data, physician authorizations, and preferred providers; document and provide updates.
• Work with the reimbursement and patient billing departments to flag transplant patient accounts for cost reporting.
• Collaborate with the contracting department to establish single case agreements when necessary; follow up on these payors and assist in contracting efforts.
• Attend patient multidisciplinary conferences to provide updates on financial clearance for patients awaiting organ transplantation.
• Coordinate efforts with admissions, business office, medical records, pharmacy, financial services, social services, and risk management for transplant intake and financial clearances.
• Consult with managed care organizations and release patient medical records to insurance carriers, referring providers, and dialysis units as appropriate.
• Collaborate with Finance and Managed Health Resources staff to ensure proper billing under global contracts/Center of Excellence agreements. Resolve conflicts involving authorization and reimbursement challenges.
• Participate in on-call coverage for insurance verification for incoming transplant patients as required.

High School Diploma/GED with 3 years of insurance related experience or associate's degree and 1 year of insurance related experience or bachelor's degree in related field

n/a

High School Diploma/GED with 3 years of insurance related experience or associate's degree and 1 year of insurance related experience or Bachelor's degree in related field

Work is primarily sedentary in nature; no special demands are required.

The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education

Bachelor's Degree

Certification / Registration / License

CFTC Certification

Work Experience

Transplant insurance experience

All responsibilities and requirements are subject to possible modification to reasonably accommodate individuals with disabilities.

This job description in no way states or implies that these are the only responsibilities to be performed by an employee occupying this job or position. Employees must follow any other…