Transplant Financial Coordinator - Hybrid

The Financial Coordinator acts as a resource and financial counselor for transplant candidates and their families, providing financial guidance in a compassionate and tactful manner in order to help facilitate access and provide continuity of care. The Financial Coordinator works extensively with the transplant team members, third party payers, government agencies, other funding agencies and hospital financial/billing staff. He/she facilitates transplant billing and provides quality service to patients by providing comprehensive and ongoing financial counseling and by identifying and helping to resolve financial coverage issues.

Overall duties

* Meets with potential transplant patients to assess financial means and needs, and provide financial information and resources as needed. Assists with financial planning.
* Obtains detailed patient insurance benefit information and assists with verification of coverage relating to all aspects of the transplant process, including but not limited to: evaluation, transplantation, outpatient prescription drug benefits, post-transplant services, out-of-pocket maximums, and travel and housing if necessary. Determines co-payment expectations and other potential out-of-pocket liability.
* Serves as a resource for patients and family members on financial matters throughout the transplant process. Works with patients, their families, and transplant team members to address insurance coverage gaps and issues and investigates alternative funding options as necessary.
* Advises transplant candidates on insurance and funding options including providing information regarding alternate funding and choices of insurance coverage i.e., Medicare and Medicaid eligibility, COBRA, Social Security Disability, retirement plans, etc. Provides information to patients regarding available medication assistance programs and assistance with co-payments, and organizations that can assist with fund-raising. Assists with applications, eligibility guidelines and other necessary paperwork or process issues to access such assistance.
* Keeps apprised of changes in federal and state (FDA/HFCA, etc.) guidelines and policies related to organ transplantation.
* Obtains all necessary payer authorizations, verifies transplant coverage and other medical benefits as needed for pre/post transplant and VAD patients.
* Monitors and updates information regarding insurance data, authorizations, and preferred providers on a regular basis. Follow-ups with patients throughout the transplant process as necessary for financial needs.
* Working with hospital staff and division finance/billing staff, facilitates resolution of patient billing issues.
* Keeps clinical staff informed of all patient financial information and alerts staff to any issues that may impact patient's ability to undergo services during the transplantation process.
* Serves as a routine resource to the Transplant team and provides explanation to the clinical and administrative staff in regard to transplantation reimbursement criteria and insurance coverage.
* Participates in transplant program multi-disciplinary and/or other patient management meetings and is prepared to provide pertinent financial information.
* Responsible for managing the charge router and organ acquisition work queues in EPIC.
* Participates in patient orientation sessions and/or other patient information forums as required.

Transplant Service Line
* Monitor provider enrollment.
* Sends out weekly open encounter reports to ensure encounters are closed in a timely manner.
* Acts as a billing coordinator to support coding and billing inquiries.
* Maintain financial and denial WQs and reports.
* Cross coverage includes review of all clinics a week in advance to ensure a referrals and authorizations are on file for pre and post-transplant patients.

Administration

* Send out patient financial overview via epic or mail
* Documents patient calls and status updates in epic
* Monitor the shared outlook mailbox and have a response rate of 24-48 hours to emails
* Scan in authorization responses from payers in epic
* Upload appropriate documents into epic and or payer websites/portals
* Run reports daily or weekly in epic
* Join and participates in recurring team meetings

Other

* Participates in quality assurance and process improvement projects as appropriate.
* Participates in relevant special projects.
* Performs other duties as assigned and/or required.

Education
- High School Diploma requires

- Bachelors Degree a plus!

Experience

- 1-2 years of direct experience with healthcare insurance benefits, preferably in a hospital setting. Experience with transplant financial issues and/or insurance coverage a strong plus.

- Demonstrated strong experience working effectively with patients, doctors and nurses.

- Experience with transplant financial issues and/or insurance coverage a strong plus

Knowledge, Skills and Abilities

- Ability to work effectively in a team and multi-disciplinary environment
- Strong attention to detail and organization.

- Must have the ability to work independently, follow up on tasks, and use judgement.

- Must be a "team player" and enjoy working with people both on the telephone and in-person; ability to deal effectively with difficult people.

- Excellent interpersonal and communication (oral, written, e-mail, grammar) skills necessary.

- Excellent computer skills; proficient with Microsoft Word, Excel, PowerPoint.

- Knowledge of the patient access processes (i.e. admitting, pre-op, registration).

- Medical terminology knowledge a must.

- Ability to work effectively in a team and multi-disciplinary environment.

Licenses and Credentials

No

NA

OTHER DUTIES AND RESPONSIBILITIES

- Works within legal, regulatory, accreditation and ethical practice standards relevant to the position and as established by BWH/Partners

- Follows safe practices required for the position.

- Complies with appropriate BWH and Partners policies and procedures.

- Fulfills any training required by BWH and/or Partners, as appropriate.

- Brings potential matters of non-compliance to the attention of the supervisor or other appropriate hospital.

Physical Requirements

• Standing Occasionally (3-33%)
• Walking Occasionally (3-33%)
• Sitting Constantly (67-100%)
• Lifting Occasionally (3-33%) 20lbs - 35lbs
• Carrying Occasionally (3-33%) 20lbs - 35lbs
• Pushing Rarely (Less than 2%)
• Pulling Rarely (Less than 2%)
• Climbing Rarely (Less than 2%)
• Balancing Occasionally (3-33%)
• Stooping Occasionally (3-33%)
• Kneeling Rarely (Less than 2%)
• Crouching Rarely (Less than 2%)
• Crawling Rarely (Less than 2%)
• Reaching Occasionally (3-33%)
• Gross Manipulation (Handling) Constantly (67-100%)
• Fine Manipulation (Fingering) Frequently (34-66%)
• Feeling Constantly (67-100%)
• Foot Use Rarely (Less than 2%)
• Vision - Far Constantly (67-100%)
• Vision - Near Constantly (67-100%)
• Talking Constantly (67-100%)
• Hearing Constantly (67-100%)