Transplant Financial Coordinator-Hybrid

Mayo Clinic•Phoenix, AZ

1d•Hybrid

About The Position

The Transplant Financial Coordinator is an advanced-level role that resolves referral, precertification, prior authorization, and financial-clearance issues throughout the pre-transplant and post-transplant process. The coordinator works professionally with patients to explain financial obligations and identify options for meeting financial requirements. This includes assessing eligibility for financial assistance and insurance coverage, arranging payments, and collecting preservice payments and copayments as needed. The position may support work across all Mayo Clinic sites regardless of the coordinator’s physical location. It may also include pre-appointment insurance review (PAIR) and denials recovery within the Patient Access Prior Authorization department. The coordinator interprets insurance eligibility and transplant contracts, and submits Letter of Agreement (LOA) and Individual Case Negotiation (ICN) requests to address network-coverage or self-pay issues. The coordinator may participate in transplant selection committee meetings, providing financial input to help determine whether potential recipients are accepted or denied and to establish transplant listing status. The role may also involve collaborating with a multidisciplinary team to develop and implement transplant patient protocols and standards of care. The coordinator monitors and updates documentation required by United Network of Organ Sharing (UNOS) guidelines, potentially including listing, status changes, and post-transplant follow-up information. The role requires compliance with quality-assurance guidelines and productivity standards. This is a hybrid position. The employee must live within 100 miles of a Mayo Clinic campus to meet onsite expectations based on business needs. Visa sponsorship or transfer is not available for this vacancy.

Requirements

High school diploma or GED.
At least 5 years of experience in medical billing (hospital and/or professional), customer service, and/or a finance-related field.
Advanced knowledge of ICD-10 and CPT coding.
Advanced knowledge of third-party payor referrals and authorizations.
Excellent written and grammatical skills, including proper phone etiquette.
Advanced computer and keyboarding skills.
Maintain regular and acceptable attendance.

Nice To Haves

Associate degree or higher.
Certification as a Transplant Financial Coordinator (CTFC).
Healthcare Financial Management Association (HFMA) certification.
Transplant financial counseling and billing experience.
Financial, analytical, and mathematical competencies.
Competence and experience with Epic.
Advanced knowledge of medical billing, reimbursement, and collections processes.
Advanced knowledge of healthcare and transplant terminology.
Knowledge of insurance contracts and managed care.
Knowledge of solid organ transplants, bone marrow transplants (BMT), End Stage Renal Disease (ESRD), and Chimeric antigen receptor (CAR)-T cell therapy.
Knowledge of transplant billing requirements.
Knowledge of Conditions of Participation (CoP), National Marrow Donor Program (NMDP), National Organ Procurement and Transplantation Network (OPTN), Scientific Registry of Transplant Recipients (SRTR), and applicable Federal Register rules and regulations for organ acquisition.

Responsibilities

Resolve referral, precertification, prior authorization, and financial-clearance issues through the pre-transplant and post-transplant process.
Explain patients’ financial obligations and provide options for meeting financial requirements.
Assess eligibility for financial assistance and insurance coverage, establish payment arrangements, and collect preservice payments and copayments as needed.
Interpret insurance coverage eligibility and transplant insurance contracts.
Submit Letter of Agreement (LOA) and Individual Case Negotiation (ICN) requests to address in-network, out-of-network, or self-pay issues.
Potentially perform pre-appointment insurance review (PAIR) and denials recovery functions within the Patient Access Prior Authorization department.
Potentially participate in transplant selection committee meetings and provide financial input on recipient acceptance or denial and transplant listing status.
Potentially collaborate with a multidisciplinary team to develop and implement transplant patient protocols and standards of care.
Monitor and update documentation required by UNOS guidelines, including applicable listing, status-change, and post-transplant follow-up information.
Follow quality-assurance guidelines and established productivity standards.