Kidney Transplant Financial Manager

Boston Medical Center•Boston, MA

48d

About The Position

The Kidney Transplant Financial Manager serves as the primary point person for all financial planning for BMC's pre and post-kidney transplant patients. The individual is responsible for obtaining patient insurance benefit and financial information in order to provide comprehensive insurance option counseling that will optimize patient's access to, and coverage of transplantation services. The Kidney Transplant Financial Manager will serve as a committee member on the Multidisciplinary Kidney Transplant Listing Meeting and is responsible for overseeing that appropriate authorizations are obtained and documentation is prepared to allow for appropriate listing to the organ-offer wait-list. The candidate will also be responsible for reviewing all charges, both inpatient and outpatient, on all transplant accounts to ensure they are processed correctly and in compliance with regulatory agencies. Additionally, the Kidney Transplant Financial Manager will be the primary financial monitor for the Center for Medicare Services, United Network for Organ Sharing, and New England Donor Services financial policies and work with kidney transplant staff and the hospital finance staff to ensure understanding and compliance of guidelines and regulations. The individual will assist surgery leadership and hospital finance leadership with transplant financial projects from start to finish, participating in multi-professional working groups focused on improving the financial journey of kidney recipients and living donors through the kidney transplantation program at BMC.

Requirements

Bachelor's Degree with preference for concentration in Economics, Business, Accounting or Finance.
Significant directly relevant experience will be considered in lieu of degree.
Minimum of 2 years direct experience with healthcare insurance benefits, preferably in a hospital setting
Demonstrated strong experience working effectively with patients, doctors and nurses.
Must be able to interpret state and federal policy guidelines and educate others on policy regulations in an effective manner
Must have the ability to work independently, follow up on tasks and use good judgment
Must be a "team player" and enjoy working with people both on the telephone and in-person; ability to deal effectively with difficult people.
Excellent interpersonal and communication (oral, written, e-mail, grammar) skills necessary.
Excellent computer skills; proficient with Microsoft Word, Excel, Visio, Zoom.

Nice To Haves

Transplant Financial Coordinator Certificate
Certified Professional Biller
Experience with transplant systems, i.e. Epic, Phoenix, UNOS is a strong plus
Experience with healthcare regulatory agencies (Medicare/ Medicaid)and compliance reporting is a strong plus
Experience leading teams with projects is a strong plus

Responsibilities

Meets with potential transplant patients to assess financial means and needs, and provide financial information and resources as needed. Assists with financial planning.
Obtains detailed patient insurance benefit information and assists with verification of coverage relating to all aspects of the transplant process, including but not limited to: evaluation, transplantation, outpatient prescription drug benefits, post-transplant services, out-of-pocket maximums, and travel and housing if necessary. Determines co-payment expectations and other potential out-of-pocket liability.
Serves as a resource for patients and family members on financial matters throughout the transplant process. Works with patients, their families, and transplant team members to address insurance coverage gaps and issues and investigates alternative funding options as necessary.
Advises transplant candidates on insurance and funding options including providing information regarding alternate funding and choices of insurance coverage i.e., Medicare and Medicaid eligibility, COBRA, Social Security Disability, retirement plans, etc. Provides information to patients regarding available medication assistance programs and assistance with co-payments, and organizations that can assist with fund-raising. Assists with applications, eligibility guidelines and other necessary paperwork or process issues to access such assistance.
Participates in transplant program multi-disciplinary and/or other patient management meetings and is prepared to provide pertinent financial information.
Ensures that all necessary payer authorizations are obtained prior to listing, verifies transplant coverage and other medical benefits as needed for pre/post-transplant and living donor patients prior to services rendered.
Keeps clinical staff informed of all patient financial information and alerts staff to any issues that may impact patient's ability to undergo services during the transplantation process.
Serves as a routine resource to the Transplant team and provides explanation to the clinical and administrative staff in regard to transplantation reimbursement criteria and insurance coverage.
Implements policies to meet transplant financial regulatory requirements in accordance with Medicare/ Medicaid and UNOS guidelines
Uphold these regulatory policies by educating transplant and hospital staff with the ability to identify non-compliance and provide solutions for teams to meet regulation requirements
Leads projects related to transplant financials from inception to completion
Manage working groups with multi-professional teams, including epic/ phoenix analysts, revenue cycle, accounts payable, and reimbursement teams
Provide content expertise for transplant billing and charge coordination for hospital billing and professional billing teams
Effectively research Medicare and Medicaid regulatory requirements and insurance payor contracting requirements, and stay up-to-date on legislation changes that impact these regulations
Attends local, national, and international meetings and conferences to remain current regarding issues relevant to the performance of transplant financial duties.
Performs other duties as assigned or as needed.
Working with division staff and finance/billing staff, facilitates resolution of patient billing issues.
Responsible for managing the account review, charge router, and organ acquisition work queues in EPIC.
Ensures patient registration is entered accurately and according to CMS rules for payment of transplant and live donor services
Reviews all hospital facility charges and professional fees to ensure payment by appropriate entity; hospital or transplant
The Financial Manager collaborates with the hospital finance department to ensure that all appropriate transplant costs are entered in the Medicare Cost Report to optimize reimbursement activities
Oversees collection of Medicare Cost Report time study data one week per month from all staff and providers involved with pre- and post-transplant services.