Transplant Financial Coordinator

Medical University of South Carolina•Charleston, SC

1d•Onsite

About The Position

The Transplant Financial Coordinator, under minimal supervision, is responsible for the analysis, validation, regulatory and compliance activities associated with coordinating financial aspects of care for adult and pediatric transplant candidates, donors, and their families. The TFC mitigates the financial risk to MUSC by performing an accurate financial clearance review along with a comprehensive analysis of patient and payor specific benefits and patient liability. Performs a variety of complex business functions, collates financial and clinical documentation, conducts research, analyzes and organizes data, implements and coordinates financial aspects of care, conducts financial screening assessments, and functions as a liaison between transplant candidates, the transplant center, and insurance payors. Serves as a subject matter expert of complex contracts, payor requirements, CMS coverage regulations and related billing practices, and governing transplant regulations and policies regarding solid organ transplantation. The Transplant Financial Coordinator advises patients on the complexities of solid organ insurance benefits and informs patients of the prior authorization/referral requirements. Operates as a resource to patients and their families, clinical staff, physicians, MUSC’s managed care, billing teams and insurance companies. Responsible for the administrative/financial clearance decision to list a patient for solid organ transplantation. The TFC position serves as part of a multidisciplinary team charged with the responsibility of providing accurate financial evaluations and analysis as well as determining financial risk involved for MUSC, transplant physicians, and patients seeking transplant services. This includes determining the patient's benefits available for evaluation, pre-transplant maintenance, and transplant admission, obtaining inpatient and outpatient authorizations for hospital and physician services, and ensuring that necessary communication occurs between the payor, and MUSC for appropriate and accurate billing and reimbursement of services. Responsible for ensuring the accuracy of financial charges and reimbursement. This individual will utilize Epic, Excel, external private and governmental databases to analyze and facilitate efficient processing of claim reimbursement. Performs duties with a significant degree of independent judgement and decision making due to the extensive level of coordinating and managing all aspects related to insurance benefit information, authorization, billing and collections for each type of transplant service performed. Creates bundled global periods, works with managed care and the revenue cycle to ensure payment and assist in trouble shooting problems. Correctly notifies billing staff of accurate account disposition to match appropriate single case agreements and accurate contractual guidelines.

Requirements

Bachelor degree from an accredited university and two years of healthcare experience or high school diploma and 5 years of job experience in referral management, oncology navigation or patient access.
Considerable knowledge of complex medical terminology.
Strong interpersonal skills.
Ability to establish and maintain collaborative relationships both internally and externally.
Strong organizational skills.
Ability to rapidly prioritize/reprioritize.
Strong verbal and written communication skills.
Ability to work autonomously and in teams.
Critical-thinking skills.
Ability to multi-task.

Responsibilities

Analysis, validation, regulatory and compliance activities associated with coordinating financial aspects of care for adult and pediatric transplant candidates, donors, and their families.
Performing an accurate financial clearance review along with a comprehensive analysis of patient and payor specific benefits and patient liability.
Collating financial and clinical documentation, conducting research, analyzing and organizing data.
Implementing and coordinating financial aspects of care.
Conducting financial screening assessments.
Functioning as a liaison between transplant candidates, the transplant center, and insurance payors.
Serving as a subject matter expert of complex contracts, payor requirements, CMS coverage regulations and related billing practices, and governing transplant regulations and policies regarding solid organ transplantation.
Advising patients on the complexities of solid organ insurance benefits and informing patients of the prior authorization/referral requirements.
Operating as a resource to patients and their families, clinical staff, physicians, MUSC’s managed care, billing teams and insurance companies.
Making the administrative/financial clearance decision to list a patient for solid organ transplantation.
Providing accurate financial evaluations and analysis as well as determining financial risk involved for MUSC, transplant physicians, and patients seeking transplant services.
Determining the patient's benefits available for evaluation, pre-transplant maintenance, and transplant admission.
Obtaining inpatient and outpatient authorizations for hospital and physician services.
Ensuring that necessary communication occurs between the payor, and MUSC for appropriate and accurate billing and reimbursement of services.
Ensuring the accuracy of financial charges and reimbursement.
Utilizing Epic, Excel, external private and governmental databases to analyze and facilitate efficient processing of claim reimbursement.
Coordinating and managing all aspects related to insurance benefit information, authorization, billing and collections for each type of transplant service performed.
Creating bundled global periods.
Working with managed care and the revenue cycle to ensure payment and assist in trouble shooting problems.
Notifying billing staff of accurate account disposition to match appropriate single case agreements and accurate contractual guidelines.