Patient Financial Coordinator - Transplant

Duke Careers•Durham, NC

1d•Hybrid

About The Position

At Duke Health, the Patient Financial Coordinator - Transplant (TFC) is a key member of the multidisciplinary team within the Patient Revenue Management Organization (PRMO). This role is responsible for providing accurate and professional financial clearance for patients seeking Transplant Services. The TFC verifies demographic and financial information, interprets insurance benefits, performs financial counseling and screening, and establishes financial arrangements. They also refer patients to appropriate internal and external agencies for discharge and post-hospital care, and collaborate with Utilization Review and Transplant Billing to ensure correct and timely reimbursement. The position involves coordinating administrative services for transplant financial services, communicating with patients and clinical teams (physicians, nurses, social workers, pharmacists), attending required meetings, and managing transplant work queues.

Requirements

High School Diploma required.
Three years of healthcare experience with a minimum of one year in insurance verification, authorization, or billing experience required.

Nice To Haves

Advanced degree preferred.
One year of experience with a transplant or chemo therapy program preferred.
Position may be subject to membership with the Transplant Financial Coordinators Association (for Transplant team) and may be subject to certification with TFCA.

Responsibilities

Provide accurate and professional financial clearance to patients seeking Transplant Services at Duke, including verifying demographic and financial information, interpreting insurance benefits, performing financial counseling, and financial screening.
Establish financial arrangements and refer appropriate cases to internal and external agencies for patient assistance.
Coordinate administrative services and operations for transplant financial services, including communication with patients and the clinical team.
Attend weekly and monthly required meetings and maintain transplant work queues.
Process referrals for transplant evaluation, including detailed patient insurance benefit information, review benefits with patients/families, and obtain payer authorizations.
Coordinate communication between insurance companies, governmental agencies, providers, and internal departments.
Work with DUHS Finance, Managed Care Contracting, and Pharmacy assistance programs for agreements.
Interact with Transplant and Oncology Clinical teams to obtain treatment plans, discharge planning, and patient demographics for insurance verification.
Prepare financial packets based on patient benefits, financial interviews, and estimated expenses, and share financial screens with clinical teams.
Notify patients not financially approved for evaluation and redirect them to insurance payer case managers.
Facilitate resolution of transplant patient billing issues, utilizing clinical and billing knowledge to resolve errors and inconsistencies.
Understand federal and state guidelines related to organ transplant.
Maintain patient data and billing information in Maestro and the transplant database, including updating demographic and insurance information.
Perform ongoing financial review and analysis of patient eligibility, benefit changes, and financial status for up to one year post-transplant.
Provide weekend and evening coverage for solid organ transplant referrals.
Update demographic and insurance information in Maestro Care, obtain Duke Medical Record numbers, and analyze benefits for appropriate coverage.
Resolve Maestro Care alerts, add/edit insurance, clear TES edits and Hold bills, and obtain authorizations/pre-certifications.
Meet with patients and family members to inform them of anticipated costs, patient liability, and responsibilities, and assist with financial plans.
Implement collection actions, explain billing policies, and evaluate patient requests for financial assistance.
Notify clinical teams of financial considerations that may prevent or delay patient listing or treatment.
Refer patients to Manufacturer Drug programs and Pharmacy Assistance programs for medications.
Analyze benefit requirements and initiate requests for authorization/prior approval for various transplant and chemotherapy services.
Prepare medical packets for prior approval, authorization, or pre-certification.
Review denials and initiate the appeal process with insurance payers, working collaboratively with patients, families, and physicians.
Provide customer service, including building rapport with patients, screening callers, triaging and responding to calls, and resolving problems/complaints.
Set next review dates, request updates to transplant approval dates, and review outpatient appointments for active transplant patients.
Identify operational improvements and communicate opportunities to management.
Perform other related duties incidental to the work described.