Transplant Financial Advisor Lead
About The Position
The Transplant Financial Advisor Lead serves as a subject matter expert and team lead for financial clearance and reimbursement activities related to complex cellular therapies, including stem cell transplant, CAR-T therapy, gene therapy, tumor-infiltrating lymphocyte (TIL) therapy, and high-cost oncology treatments. The role provides leadership, training, operational support, and escalation management to help ensure patients receive timely financial clearance and access to treatment. The Lead collaborates with physicians, clinical teams, pharmacy, authorization specialists, payors, patient access departments, and revenue cycle leadership to navigate insurance requirements, financial assistance programs, and self-pay arrangements. The position also supports departmental initiatives, workflow development, onboarding, and implementation of new projects and services.
Requirements
- High school graduate or GED.
- At least 5 years of experience in financial advising, claims processing, benefits explanation, cost estimates, benefit pricing, or patient accounting.
- Obtain Transplant Financial Advisor Certification within 6 months of hire.
- Knowledge of CPT-4 and HCPCS coding.
- Knowledge of commercial and government insurance.
- Familiarity with payor websites.
- Understanding of transplant (BMT and/or solid) procedures as they relate to coding and billing.
- Working knowledge of CMS regulations.
Nice To Haves
- Associate degree in Health Care Administration, Finance, or a related field of study from an accredited college or university.
- At least 6 years of Epic experience.
Responsibilities
- Maintain and review financial clearance activities for stem cell transplant, CAR-T, gene therapy, TIL, and high-cost oncology treatments.
- Provide initial and ongoing employee training, orient new employees to department and shift policies and procedures, and support cross-training.
- Assist the Supervisor with monitoring daily work queues of unsecured accounts and follow up with team members to meet work queue goals.
- Support Patient Financial Advisors by answering questions and directing them to appropriate policies, procedures, and resources.
- Handle escalated patient concerns and complex financial clearance issues.
- Coordinate complex financial clearance cases with case management.
- Oversee referrals to vendors and monitor Patient Financial Advisors' work queues.
- Contact patients or family members to ask questions about potential sponsorship and coverage sources, including health, homeowner’s, workers’ compensation, and auto insurance; prepaid packages; grants; studies; COBRA; VA benefits; Crime Victim benefits; Medicaid; and Medicare.
- Comply with Medicare and Medicaid rules and regulations.
- Negotiate settlements or establish payment arrangements; screen patients unable to pay for partial or full charity assistance, complete financial assessment applications, and obtain required documents.
- Recommend accounts for collections and ultimately bad debt when patients are uncooperative during the screening process.
- Work daily unsecured-account work queues by taking appropriate actions, including phone calls and written communication, and using appropriate codes and timeframes.
- Serve as a liaison among patients, family members, and other health care personnel, and work with team members on patient and family interactions requiring financial support.
- Lead the team in the absence of the supervisor or manager, or upon assignment.
- Perform the professional, clinical, and/or technical competencies of the assigned unit or department.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
High school or GED
