Program Lead Transplant Financial Coordinator

Overview

The Program Leader - Transplant Financial Coordinator is an integral member of the multidisciplinary transplant team with a broad range of responsibilities that include Patient Access Management, Patient Resource Management, Insurance Authorization Management, Grant Management, Compliance Management, Patient Financial Counseling/Education, as well as staff training and supervision. Provides expertise to transplant division leadership to achieve operational goals with a focus on operational efficiency, finance, process improvement and workflow.

The Program Leader Transplant Financial Coordinator is a resource to patients, their families, and all members of the transplant team who facilitates patient access to all transplant-related services to ensure continuity of care. The Program Leader Transplant Financial Coordinator fosters strong partnerships with interdepartmental leadership and key external agencies to optimize patient access to care and ensure appropriate reimbursement from payors and other responsible entities.

Assists surgery leadership and hospital finance leadership with transplant financial projects from start to finish, participating in multi-professional work groups focused on improving the financial journey of kidney recipients and living donors through the kidney transplantation program at Dartmouth Health (DH).

• Performs detailed benefit investigation for all patient referrals to ensure DH is in-network with the patient s plan prior to patient acceptance in the DH Kidney Transplant Program.
• Preserves patient retention and eliminates barriers to transplant at DH by counseling patients with out-of-network insurance on in network options. Assists with enrollment as necessary. Facilitates Single Case Agreements for out-of-network plans.
• Informs patients of detailed insurance coverage relating to all aspects of the transplant process. Discusses patient s ability to manage transplant-related costs. Explores fund raising and alternate funding options available to eliminate financial barriers when possible. Advises patients regarding choices of insurance coverage to best meet their individual needs, i.e., COBRA, Medicare/Medicaid eligibility, Medicare Supplement Plans, and Medicare Advantage Plans.
• Provides detailed information regarding End-Stage Renal Disease (ESRD) Medicare coordination of benefits rules and financial risk should they not enroll. Counsels and assists patient enrollment in ESRD Medicare at the appropriate time to prevent patient from becoming inadvertently uninsured.
• Advises of options for Medicaid disability income, Social Security disability income, as well as short and long-term employer disability income.
• Develops and maintains patient education and resource materials to keep current with industry and regulatory standards.
• Investigates available options and facilitates enrollment in transplant medication assistance programs and copay card initiatives in compliance with federal eligibility guidelines. Connects patients to available community resources as necessary
• Cross-covers completion of insurance covered ride requests, FMLA forms, Advance Directives, and applications to donor assistance programs.
• Solves issues that prohibit patients from accessing critical medications by working with pharmacies and insurance companies to resolve claims. Assists with locating pharmacies that have stock of critical transplant medications during periods of product shortages. Collaborates with pharmaceutical industry representatives to resolve issues, including supply chain issues, inhibiting patient access to medications.
• Maintains knowledge of available grant program criteria and connects patients as appropriate.
• Tracks enrolled waitlist patients for the American Kidney Foundation and takes over management from the dialysis unit upon transplant.
• Ensures compliance with memorandum of understanding (MOA) with the Knights of Columbus Medication Assistance, screens and approves patients for grant funding, maintains record of funds dispersed, prepares quarterly report for submission to the Knights, maintains relationship with the Knights including meeting as necessary to ensure longevity of the program.
• Coordinates and leads team discussion to determine use of Shaun Harington Fund grant to support various patient needs to facilitate access to transplant. Maintains record of funds dispersed.
• Prepares and submits payment requests to accounts payable (A/P).
• Serves as a resource to the DH Contracting Managers by staying informed of transplant industry contracting trends to maximize opportunities for increased reimbursement. Maintains knowledge of contract terms, insurance plan requirements including network status, authorization, and billing processes.
• Informs clinical staff of required testing per individual insurance plan criteria to facilitate patient progress through the transplant phases.
• Collaborates with Conifer Managers to ensure timely authorizations for necessary testing and…