Job Details:

Job Summary:

The Financial Coordinator is a member of the multidisciplinary team in the Transplant Center and has primary responsibility for coordinating financial aspects of care throughout all phases of the transplant process. The Financial Coordinator acts as a resource and financial counselor for transplant candidates and their families, potential living donors and their families, the Transplant Team, third party payers, Patient Accounts, and reimbursement staff. He/she provides quality service to patients by providing comprehensive and ongoing financial counseling; identifying administrative and financial problems involving reimbursement for transplant related services and interfaces with relevant departments, clinical and administrative staff.

Responsibilities:

Obtain detailed patient insurance benefit information including, but not limited to: outpatient prescription drugs, organ acquisition, follow-up clinic visits, and travel and housing if necessary. Research and verify type of coverage, limitations, exclusions, etc. Discuss benefits and other financial issues with patients and or family members during initial evaluation. Advise patients about insurance and billing issues and options. Serve as a resource for patients and family members on financial matters. Serve as a resource to transplant candidates to assist with alternate funding and choices of insurance coverage, i.e., Medicare and Medicaid eligibility, COBRA, Social Security Disability, retirement plans, etc. Assist with applications, eligibility guidelines and with billing related issues. Keep apprised of changes in federal and state guidelines (FDA/HCFA) and policies, related to organ transplantation. Advise transplant candidates and living donors about any potential impact for out-of-pocket expenses; childcare cost; possible loss of employment; potential impact on ability to obtain future employment; potential for disability benefits and need for assistance completing relevant paperwork; impact on ability to obtain health & life insurance. Obtain payer authorizations and verify transplant coverage and other medical benefits. Coordinate billing process in accordance with managed care contractual agreements. Submit clinical data requested by third party payers. Monitor and update information regarding insurance data, physicians, authorizations, and preferred providers every six months or more often if necessary. Keep clinical staff apprised of patient/donor financial information as it relates to: candidate listing and subsequent transplant surgery benefits. any issues that may impact patient’s ability to undergo transplant. Collaborate with the Transplant Social Worker on complex cases to ensure financial coverage for medications and post-transplant care. Serve as a resource to the Transplant Team, provide explanation, as needed to clinical and administrative staff in regard to transplantation review and reimbursement criteria. Maintain data reports for each transplant program. Review all transplant donor related services and respective charges, and works with managed care contract staff, Patients Accounts staff, and Reimbursement personnel, in processing donor claims and resolving all transplant services financial matters, as required. Participate in Quality Assessment & Performance Improvement (QAPI) activities. Qualifications/Requirements:

Experience:

Minimum two years of experience in healthcare related field, preferred. Experience in insurance verification, prior authorization, eligibility and benefits. Knowledge and/or experience in organ transplantation desirable.

Education:

College Degree, minimum Associates degree or equivalent, Bachelors preferred.

Licenses / Certifications:

NA

About Us:

WMC Advanced Physician Services PC

Benefits:

We offer a comprehensive compensation and benefits package that includes:

Health Insurance Dental Vision Retirement Savings Plan Flexible Savings Account Paid Time Off Holidays Tuition Reimbursement

 

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