Transplant Financial Coordinator - Days

Essential Job Statements

Performance Expectation: Financial Services

The transplant financial coordinator manages the financial services and resources of solid organ/VAD/TPIAT patients to include research and verification of insurance coverage and maximums for specialty services; initiation of referrals for fund-raising, financial assistance or applicable public benefit options which is predicated on discussions with patients about their financial obligations including co-payments, fund-raising and deposits; initiate, obtain and follow-up on authorizations and pre-certifications for services and/or associated prescription drugs prior to scheduled appointments including future date surgeries, urgent and emergent admissions; and, when necessary, provides estimates to patients as requested.

Performance Expectation: Communications

The Transplant Financial Coordinator acts as a representative of the Hume-Lee Transplant Center to internal and external groups regarding financial questions, policies, contracts, data reporting, and all aspects of transplant financial operations.

Communicates with patients, families and/or guarantors via financial interview to advise on the status of benefits and upcoming hospital or clinic visits, and throughout all the phases of patient's care through one-on-one interviewing over the phone and/or in-person to interpret benefits and other transplant/VAD/TPIAT financial information.

Participates in the initial patient orientation process and provides ongoing patient education on the transplant/VAD/TPIAT needs by identifying and effectively presenting financial information and clearance to transplant/VAD/TPIAT team members in multidisciplinary meetings, weekly Patient Selection Meetings as well as ad-hoc collaborative meeting

Ensure comprehensive communication to patients and their families with emphasis on identifying any potential patient out-of-pocket liability, potential costs for post-care medications, and home health care related to services following surgery.

Communicates and corresponds with the staff, physician and hospital medical and billing staff and third-party payers regarding patient financial issues.

Responds to inquiries within 3 business days, coordinates and provides any requested/required documentation regarding patient financial issues.

Attends and participates in weekly division/ department or program team meetings, providing additional information/documentation as requested.

Performance Expectation: Documentation & Reporting

Establishes procedures, systems and protocols to ensure that accurate and timely flow of information necessary for the CBO to effectively and accurately bill for services rendered to recipients and living donors to include VAD and TPIAT candidates; In collaboration with multi-disciplinary team, provides ongoing guidance and feedback to clinical staff about denials reasons, appeals and their outcomes, and managed care contractual requirements.

Performance Expectation: Coordination with Financial Resources

May facilitate with revenue cycle and managed care partners to address and resolve complex patient billing issues, identifies and seek resolution of insurance billing edits and denials, establishes appropriate quality assurance standards for medical records documentation and collect and monitor data to ensure maximum reimbursement for the physician practice and the medical center.

When necessary, participates in the coordination of single case agreements-led by the managed care team-for non-contracted health plans, including global transplant, VAD and TPIAT networks using patient's out of network benefits.

Responsible for counseling and assisting patients with decisions regarding fundraising monies to meet clearance criteria and patient assistance programs for medications, recommendation for insurance coverage including COBRA, Social Security Disability, Marketplace and Healthcare Exchange plans and other options

Performance Expectation: Policies & Procedures

Serves as the subject-matter expert to all solid organ/VAD/TPIAT payer contracts, terms and bundles

Reviews, revises, maintains and implements the policies and procedures performed/followed by the Transplant Financial Coordinator.

Researches and maintains all third-party payer policies and updates relating to billing and reimbursement.

Maintains knowledge and understanding of all regulatory requirements for transplant/VAD/TPIAT services with CMS, UNOS, and all other regulatory-related transplant bodies; federal and state guidelines related to organ transplantation/VAD/TPIAT; CMS Conditions of Participation as related to organ transplantation/VAD/TPIAT

Performance Expectations: Administration

Assists Supervisor/Team with mentoring and training of new staff

Attends regular staffing, workgroup and multidisciplinary team meetings.

Performance Expectation: Miscellaneous Responsibilities

Performs other duties/projects as assigned by MCVP Billing Operations management, physicians, division/department or program staff, VCUHS Managed Care Department or division/department or program Administrator.

Patient Population

Not applicable to this position

Employment Qualifications

Required Education:

High School Diploma or equivalent

Combination of education and experience will be considered in lieu of a degree.

Preferred Education:

Coursework in medical terminology

Associate's or Bachelor's degree in accounting, Finance, Business Administration, Healthcare Administration or closely related field

Licensure/Certification Required:

Transplant Financial Coordinator Certification (within 18 months of hire)

Licensure/Certification Preferred:N/A

Minimum Qualifications

Years and Type of Required Experience

Minimum of three (3) years of previous Registration, Healthcare insurance, Accounts Receivable, Billing and/or Collections experience in a healthcare setting.

Other Knowledge, Skills and Abilities Required:

Independent decision-making related to financial arrangements required for transplant patients.

Cultural Responsiveness

Other Knowledge, Skills and Abilities Preferred:

Minimum of five (5) years of previous Registration, Healthcare insurance, Accounts Receivable, Billing and/or Collections experience in a healthcare setting.

Working Conditions

Periods of high stress and fluctuating workloads may occur.

General office environment.

May have periods of constant interruptions.

Prolonged periods of working alone.

Physical Requirements

Physical Demands: Lifting/ Carrying (0-50 lbs.)

Work Position: Sitting, Walking, Standing

Additional Physical Requirements/ Hazards

Physical Requirements: Manual dexterity (eye/hand coordination), Perform Shift Work, Maneuver weight of patients, Hear alarms/telephone/tape recorder, Reach above shoulder, Repetitive arm/hand movements, Finger Dexterity, Color Vision, Acuity - near, Acuity - far

Hazards: Depth perception, Use of Latex Gloves, Exposure to dust/fumes, Exposure to potential electrical shock, Exposure to x ray/electromagnetic energy

Mental/Sensory -Emotional

Mental / Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking

Emotional: Fast pace environment, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Able to Adapt to Frequent Change

This is a remote job but candidates must live in:

Arizona, Florida, Georgia, Kansas, Kentucky, Maryland, Michigan, Missouri,

North Carolina, Ohio, South Carolina, Tennessee, Texas, Virginia, or West Virginia.

EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.