Lead, Transplant Financial Coordinator - Liver Acquisition - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

Keck Medicine of USC•Los Angeles, CA

22h•$29 - $45

About The Position

The Transplant Financial Coordinator Lead will work under the direction of the TFC supervisor/manager and fulfills a leadership role over the transplant financial team to assure transplant patients' medical services are covered by insurance and patients are effectively counseled regarding their insurance plans. The TFC Lead will act as designee of the supervisor/manager to provide team cohesiveness, direction and education to the transplant financial coordinators, guides/establishes workflow processes to accelerate financial clearance for patients and streamline system operations. Essential Duties Acts as leader, mentor and professional to staff and facilitates positive change, growth and camaraderie within the department. Provides assistance to staff and guides staff in organizing daily tasks and resolving challenging financial clearance scenarios. Establish a sense of comradery among peers and with supervisor/lead TFCs to facilitate teamwork with others and throughout the department. Work well with others to problem-solve, provide coverage when necessary and assist clinical and non-clinical staff during acute and unforeseen circumstances to advance patient care. Self-directs activities and demonstrates an ability to problem-solve and escalate issues as needed. Responsible for coordinating and clarifying patient-specific insurance and financial aspects of care with less than 5% inaccuracy. Obtain and document detailed patient insurance benefit information, limitations and exclusions to determine appropriateness for transplantation services and financial criteria of program, including, but not limited to, all aspects of the transplant process: transplant surgery, organ acquisition, follow-up clinic visits, admissions, cost of labs, diagnostic testing, co-payments of outpatient prescription drugs and travel/housing benefits. Discuss benefits, and other transplant financial issues, with patients and/or family members during initial evaluation, including each time a patient’s insurance coverage changes. Serve as a resource for patients and their family members on financial and insurance matters. Provide patients with educational materials, which cover transplant financial benefits and pitfalls, coverage options and insurance types. Work with patients and their families from referral through post-transplantation in a compassionate and tactful manner, to help facilitate access to, and provide, continuity of care. Assist patients with questions concerning insurance and other financial issues. Proactively guide patients through application processes for government funded/financial assistance programs (i.e., Medi-Cal, KMC charity program, QMB, Legal Aid, LIS, etc.) and coordination of benefits, as necessary. Work with other members of the transplant team, administrative staff, billing, financial and clinical personnel at KMC to ensure financial coverage of transplant and living donor services. Alert staff to issues impacting a patient’s ability to undergo transplantation. Identify and effectively communicate financial information to transplant team members, patients and their families with emphasis on identifying any potential patient out-of-pocket liability, clearance issues, coverage gaps and alternate funding options. Maintain familiarity with UNOS and CMS regulations related to transplant finance and billing practices. Follows KMC and transplant institute policies and procedures. Apply financial guidelines, protocols and policies equally when engaging patients, families and payors. Work with clinical staff to coordinate recipient and living donor benefits, financial clearance, authorizations, planned surgical events and clarify any insurance issues related to living donation. Obtain and ensure all necessary payor authorizations, approvals and clearance. Verify transplant coverage and other medical benefits. Acquire necessary referrals/authorizations for planned admission and procedures with less than 5% inaccuracy. Assist, as needed, with financial clearance of urgent inpatient transfers and patients in need of clearance for critical or acute care. Routinely monitor insurance coverage for patients throughout all phases of transplant, particularly while patients are waitlisted for an organ. Cultivate relationships with insurance case managers and medical directors to facilitate and expedite authorization approvals. Retrieve clinical data in a timely manner when requested/required by third party payers. Facilitate resolution of patient billing issues. Serve as a liaison to USC Care and Keck billing offices to resolve billing questions and problems. Engage non-contracted health plans and medical groups to interface with Keck Hospital and USC Care contracting departments to obtain LOA, or other financial guarantees, to effectively cover transplant services from a fiduciary standpoint. Participate in the weekly transplant selection committee meetings and multidisciplinary clinics to provide financial insurance expertise specific to individual patients and candidates. Prepare financial reports for each patient prior to the clinic or selection committee to best facilitate decision-making for patients and the multidisciplinary team. Follow all HIPAA related compliance by keeping patient clinical/personal information private. This includes but is not limited to: Confirming a minimum of two patient identifiers prior to discussions with patients and staff, sending written or electronic communications and/or entering new information into electronic systems. Prior to speaking with any patient representatives confirm the representative is noted in the EMR, or transplant EMR, to receive HIPAA related information. If a HIPAA violation occurs, communicate immediately with a supervisor, quality department representative and enter the violation into the risk management system. Act as a business professional in interaction and appearance by providing superior customer service when interfacing with patients, peers, physicians, superiors and hospital personnel/leadership. Represent the transplant department in a positive and proactive way to others when discussing role and duties. Perform other duties as assigned.

Requirements

Req High school or equivalent
Req Associate's degree AA required or equivalent 2+ years transplant financial coordination experience AA required or equivalent 2+ years transplant financial coordination experience
Req 2 years Minimum of 2-5 years of financial coordination experience preferably in transplant financial.
Req Broad knowledge of health insurance terminology, health insurance process and transplant process required.
Req Knowledge of transplant database (OTTR), EMR and various IT systems required.
Req Demonstrated ability to problem-solve and provide effective resolution.
Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

Nice To Haves

Pref Bilingual strongly preferred.
Pref Certification - Job Relevant Certified Transplant Financial Coordinator (CTFC) strongly preferred.

Responsibilities

Acts as leader, mentor and professional to staff and facilitates positive change, growth and camaraderie within the department.
Provides assistance to staff and guides staff in organizing daily tasks and resolving challenging financial clearance scenarios.
Establish a sense of comradery among peers and with supervisor/lead TFCs to facilitate teamwork with others and throughout the department.
Work well with others to problem-solve, provide coverage when necessary and assist clinical and non-clinical staff during acute and unforeseen circumstances to advance patient care.
Self-directs activities and demonstrates an ability to problem-solve and escalate issues as needed.
Responsible for coordinating and clarifying patient-specific insurance and financial aspects of care with less than 5% inaccuracy.
Obtain and document detailed patient insurance benefit information, limitations and exclusions to determine appropriateness for transplantation services and financial criteria of program, including, but not limited to, all aspects of the transplant process: transplant surgery, organ acquisition, follow-up clinic visits, admissions, cost of labs, diagnostic testing, co-payments of outpatient prescription drugs and travel/housing benefits.
Discuss benefits, and other transplant financial issues, with patients and/or family members during initial evaluation, including each time a patient’s insurance coverage changes.
Serve as a resource for patients and their family members on financial and insurance matters.
Provide patients with educational materials, which cover transplant financial benefits and pitfalls, coverage options and insurance types.
Work with patients and their families from referral through post-transplantation in a compassionate and tactful manner, to help facilitate access to, and provide, continuity of care.
Assist patients with questions concerning insurance and other financial issues.
Proactively guide patients through application processes for government funded/financial assistance programs (i.e., Medi-Cal, KMC charity program, QMB, Legal Aid, LIS, etc.) and coordination of benefits, as necessary.
Work with other members of the transplant team, administrative staff, billing, financial and clinical personnel at KMC to ensure financial coverage of transplant and living donor services.
Alert staff to issues impacting a patient’s ability to undergo transplantation.
Identify and effectively communicate financial information to transplant team members, patients and their families with emphasis on identifying any potential patient out-of-pocket liability, clearance issues, coverage gaps and alternate funding options.
Maintain familiarity with UNOS and CMS regulations related to transplant finance and billing practices.
Follows KMC and transplant institute policies and procedures.
Apply financial guidelines, protocols and policies equally when engaging patients, families and payors.
Work with clinical staff to coordinate recipient and living donor benefits, financial clearance, authorizations, planned surgical events and clarify any insurance issues related to living donation.
Obtain and ensure all necessary payor authorizations, approvals and clearance.
Verify transplant coverage and other medical benefits.
Acquire necessary referrals/authorizations for planned admission and procedures with less than 5% inaccuracy.
Assist, as needed, with financial clearance of urgent inpatient transfers and patients in need of clearance for critical or acute care.
Routinely monitor insurance coverage for patients throughout all phases of transplant, particularly while patients are waitlisted for an organ.
Cultivate relationships with insurance case managers and medical directors to facilitate and expedite authorization approvals.
Retrieve clinical data in a timely manner when requested/required by third party payers.
Facilitate resolution of patient billing issues.
Serve as a liaison to USC Care and Keck billing offices to resolve billing questions and problems.
Engage non-contracted health plans and medical groups to interface with Keck Hospital and USC Care contracting departments to obtain LOA, or other financial guarantees, to effectively cover transplant services from a fiduciary standpoint.
Participate in the weekly transplant selection committee meetings and multidisciplinary clinics to provide financial insurance expertise specific to individual patients and candidates.
Prepare financial reports for each patient prior to the clinic or selection committee to best facilitate decision-making for patients and the multidisciplinary team.
Follow all HIPAA related compliance by keeping patient clinical/personal information private. This includes but is not limited to: Confirming a minimum of two patient identifiers prior to discussions with patients and staff, sending written or electronic communications and/or entering new information into electronic systems. Prior to speaking with any patient representatives confirm the representative is noted in the EMR, or transplant EMR, to receive HIPAA related information. If a HIPAA violation occurs, communicate immediately with a supervisor, quality department representative and enter the violation into the risk management system.
Act as a business professional in interaction and appearance by providing superior customer service when interfacing with patients, peers, physicians, superiors and hospital personnel/leadership.
Represent the transplant department in a positive and proactive way to others when discussing role and duties.
Perform other duties as assigned.