Transplant Financial Coordinator-Remote

Mayo Clinic•Rochester, MN

2h•Remote

About The Position

The Enterprise Transplant Financial Coordinator is an advanced level authorization representative with advanced knowledge of all solid organ and BMT pre-transplant and post-transplant processes. The position has a thorough understanding of payer requirements related to referral, precertification, prior authorization and/or financial clearance. This role requires interpretation of insurance coverage eligibility, insurance transplant contracts, and the submission of Letter of Agreement (LOA) and Individual Case Negotiation (ICN) requests to address any in/out of network coverage or self-pay issues. This position may participate or provide information for in selection committee meetings with the Transplant Team from a financial aspect to assist the committee's decision to accept/deny potential transplant recipients and the determination of the patient's transplant listing status. This role may also include participation and collaboration with a the multidisciplinary care team in the development and implementation of protocol and standards of care planned for the transplant patient. This position will be responsible for monitoring and the updating of necessary documentation according to the United Network of Organ Sharing (UNOS) and Centers for Medicare and Medicaid Services (CMS) guidelines that may include listing, status changes and post-transplant follow up information. This role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit's performance expectations.

Requirements

Advanced knowledge of all solid organ and BMT pre-transplant and post-transplant processes
Thorough understanding of payer requirements related to referral, precertification, prior authorization and/or financial clearance
Ability to interpret insurance coverage eligibility and insurance transplant contracts
Ability to submit Letter of Agreement (LOA) and Individual Case Negotiation (ICN) requests
Adherence to quality assurance guidelines and established productivity standards

Responsibilities

Courteously and professionally complete financial clearance calls
Work with patients to outline financial obligations related to care
Provide options for patients to meet financial requirements, including assessing financial assistance eligibility, determining insurance coverage eligibility, and providing estimates
Regularly monitor work queues to ensure authorizations are completed timely and escalate potential barriers or delays
Answer and resolve inbound Transplant Call Center calls timely and efficiently
Interpret insurance coverage eligibility, insurance transplant contracts, and submit Letter of Agreement (LOA) and Individual Case Negotiation (ICN) requests to address any in/out of network coverage or self-pay issues
Participate or provide information for in selection committee meetings with the Transplant Team from a financial aspect to assist the committee's decision to accept/deny potential transplant recipients and the determination of the patient's transplant listing status
Participate and collaborate with a the multidisciplinary care team in the development and implementation of protocol and standards of care planned for the transplant patient
Monitor and update necessary documentation according to the United Network of Organ Sharing (UNOS) and Centers for Medicare and Medicaid Services (CMS) guidelines that may include listing, status changes and post-transplant follow up information
Assist with staff training and cross coverage as needed
Adhere to quality assurance guidelines as well as established productivity standards to support the work unit's performance expectations