Authorization Appeals - Stem Cell Transplant

$44,886 - $73,944/Yr

City of Hope - Newnan, GA

Full-time - Mid Level

Onsite - Newnan, GA

Hospitals

About the position

The Cellular Therapy Finance Specialist at City of Hope is responsible for verifying patient insurance benefits related to stem cell transplants, CAR-T, and leukemia services. This role involves direct interaction with payers to secure insurance authorizations, ensuring timely reimbursement and minimizing financial risks for both patients and the organization. The specialist collaborates with clinical teams and participates in performance tracking to support financial decision-making within the cellular therapy program.

Responsibilities

• Verifies patient insurance benefit information for all aspects of treatment, including inpatient and outpatient services, prescription drugs, and travel and housing.
• Assesses need for alternative coverage sources.
• Provides financial counseling to patients and their families regarding stem cell transplant, CAR-T, leukemia benefits, and self-pay agreements.
• Serves as the primary resource throughout the patient's treatment, discussing benefits and financial issues from initial referral through continuation of care.
• Works with cellular therapy intake and transplant coordinators to obtain authorizations and ensure timely patient schedules and care.
• Influences the approval process through knowledge of payer policy and documentation support for clinical procedures.
• Documents all information accurately in the patient records system to ensure maximum reimbursement.
• Obtains necessary signatures and documentation required by the patient's insurance plan.
• Performs pre-registration/registration processes.
• Maintains knowledge of Medicare, Medicaid, Commercial payor benefits and criteria, especially for long-term care and low-income patients.
• Monitors and updates insurance data, authorizations, preferred providers, and changes in treatment plans.
• Partners with clinical care teams and insurance providers to ensure continued coverage and maximum reimbursement.
• Acts as a resource to patient accounting stakeholders and reviews insurance claim denials.
• Escalates approval issues to the cellular therapy finance and clinical leadership team.
• Utilizes patient account management techniques and information systems for registration, coding, billing, medical records, and accounts receivables.
• Maintains accurate statistical, contractual, and financial databases related to stem cell transplant and CAR-T programs.
• Analyzes statistical data and reports for program-specific financial indicators.

Requirements

• 3-5 years of experience in a related field; experience in stem cell transplant highly preferred.
• High school diploma or GED; Associate degree preferred.
• Working knowledge of medical and hematology/oncology terminology.

Nice-to-haves

• Working knowledge of stem cell transplant, CAR-T, and malignant hematology terminology.

Benefits

• Comprehensive health insurance
• 401k retirement plan
• Paid time off
• Tuition reimbursement
• Professional development opportunities