Financial Case Manager
About The Position
The Bone Marrow Transplant (BMT) Financial Case Manager is a critical member of the Bone Marrow Transplant multidisciplinary team(s) and works collaboratively with physicians, nurse coordinators, social workers, practice coordinators, and external insurance case managers to ensure that patients are financially eligible and cleared for services throughout the transplant process. The Financial Case Manager incorporates knowledge of BMT-specific emerging therapies, such as CAR-T, and ensures appropriate payor rules are followed. Collaborates with the Contracting Department for non-contracted payors and resolves billing issues for transplant-related services with UCSF's billing representatives. Manages a large caseload that involves counseling and education during the evaluation, waitlist, and transplant phases of care. This is a critical role and is required of all transplant programs as stated in the United Network for Organ Sharing (UNOS) bylaws. Works independently and follows the guidelines as set forth by the transplant and Patient Access Services department policies and procedures. Provides patient education on insurance rules and regulations, counseling on transplant-specific financial expectations, reviewing patient financial responsibility, coordinating the insurance process for patients for evaluation, waitlist testing, living donor workup, Autologous or Allogeneic Donor Transplant Surgery, and other specialty referral appointments as necessary. This includes obtaining all needed authorizations for above mentioned services while seeking to maximize the utilization of benefits and coordinate cost-effective care in a managed care environment for each patient.
Requirements
- Bachelor's degree in a related area or four years of relevant experience and three (3) years of experience with insurance benefits and authorizations.
- Advanced interpersonal skills to develop productive ongoing relationships with payors, outside agencies, and patients. Ability to interact with patients about financial preparedness, insurers, and other parties.
- Strong computer proficiency in all relevant applications and software, with a knowledge of spreadsheet and document applications, and a variety of specialized billing and insurance systems.
Nice To Haves
- Thorough knowledge of insurance processes, concepts, systems, and external regulations.
- Knowledge of medical terminology, coding, and billing.
- Strong analytical skills, attention to detail, conducting interviews and research, developing and recommending new systems, workflows, and procedures.
- Ability to serve as a technical leader, providing expertise and serving as an educational resource to staff and management at all levels.
- Experience working in organ transplantation.
- Transplant Financial Coordinator Certification.
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What This Job Offers
Job Type
Full-time
Industry
Educational Services
Number of Employees
5,001-10,000 employees
