Transplant Financial Coordinator

Position Summary

The Transplant Financial Coordinator (TFC) is part of a multidisciplinary team charged with the responsibility of providing accurate and professional financial counseling to patients seeking transplant services. The TFC is responsible for the analysis, validation, and regulatory and compliance activities associated with the financial clearance process. The TFC mitigates the financial risk to VMC by performing accurate financial clearance review along with a comprehensive analysis of patient and payor specific benefits and patient liability. Coordination and communication with the patient and clinical teams including physicians, nurses, social workers, and pharmacists is key for the successful financial analysis and clearance. Work is performed under the direct supervision of the Business Manager for Transplant Services.

Responsibilities

• Performs financial screening/interview of patients presenting for transplantation.
• Analyzes, organizes, and utilizes complex data and rules related to contracting and patient benefits to provide financial clearance.
• Researches and verifies insurance for hospital, professional, and pharmacy coverage.
• Provides updated financial and demographic data on all patients and donors by direct input into various databases.
• Meets with patients and family members at the time of initial transplant evaluation.
• Collects information from patients and determines what type of coverage may be obtained for patient (i.e. Medicare, Medicaid, and spend-down information). Assists the patient/guarantor in obtaining other resources if eligibility has been terminated.
• Explains billing to patients according to VMC credit and collection policies.
• Communicates with the transplant team to facilitate timely compliance in providing necessary information for authorization. Refers problems or issues to the Business Manager.
• Evaluates patient requests for financial assistance. Under direction of the Business Manager, works with VMC Finance, Managed Care Contracting, and pharmacy assistance programs in the development of agreements for self-funded patients and patients with limited benefits.
• Prepares financial packets based on each individual patient's benefits, patient financial interview, and calculated estimate of expenses based on patient benefits.
• Reviews and analyzes patient eligibility, benefit changes, and financial status once a patient is accepted for evaluation and throughout transplant process.
• Obtains pre-certification for transplants and associated procedures.
• Analyzes benefit requirements and initiates the request for authorization/prior approval for the transplant evaluation, admission, clinic visits, donor compatibility, work-up and testing, organ procurement, and follow-up appointments.
• Prepares the medical packet (including letter of medical necessity and clinical evaluation) required to obtain prior approval, authorization, or pre-certification.
• Documents authorizations in EHR per policy and procedure; logs authorizations for monthly report.
• Sets the next review date in the transplant registration screen to trigger the next financial verification period.
• Requests updates to the effective and termination dates of the transplant approval when expired.
• Adheres to contractual guidelines with insurance companies when obtaining initial or continuing authorization for services.
• Reviews denials for evaluation and/or transplant and initiates the appeals process with the insurance payer working collaboratively with the patient, family, and physician; logs denials for monthly report.
• Notifies the patient if not financially approved for evaluation at VMC and redirects these patients to the insurance payer's case manager.
• Works with Business Manager to assist finance department by providing data about transplant program and financial activities to support insurance contracts; implements and coordinates the reimbursement of approved contracts with the Business Manager.
• Makes every effort to minimize the loss of reimbursement for lack of notification, lack of authorization, or denied days due to lack of continuing authorization.
• Documents all follow-up work in the applicable database.
• Supports potential process improvement projects by collecting and compiling supporting data.
• Miscellaneous:
• Keeps up to date on job related regulations to ensure maximum financial coverage for patients and appropriate reimbursements. Adheres to regulations regarding transplantation including, but not limited to, CMS, UNOS, and Joint Commission.
• Completes time studies monthly.
• Identifies operational improvements to maximize efficiency and effectiveness of services provided. Communicates opportunities to management.
• Serves as resource for Social Work.
• Performs in accordance with accepted procedure and responds to special requests by management in a timely and accurate manner.
• Adheres to the policies and procedures. Uses tact and courtesy in all interactions including, but not limited to, staff, patients, and payers. Promotes a positive image and supports management in goals and objectives. Handles inquiries and complaints discreetly and effectively.
• Performs other related duties incidental to the work described herein.
  

Minimum Requirements

• High school plus 4 years or more experience or Associate College Degree plus 2 years experience or College degree with 1 year of experience is required.
• Experience required in Hospital, Business Office, or Physician's Office.
• Prefer experience in insurance review/verification and billing.
  
  

Other Information

• Onsite role (based out of Greenville, NC)
• Monday - Friday day shift:
• 8:00 a.m. - 4:30 p.m.
• Great Benefits
  

ECU Health

About ECU Health

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Childrens Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicants qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.