Patient Financial Advisor -Transplant

Position Summary / Career Interest:

Assists all transplant patients and families navigate through the insurance and financial aspects of transplant care with the enterprise. Assists patients/ families to secure payer sources including insurance coverage, Medicaid/ Medicare and other sources available based on need. Follows the enterprise financial clearance and financial assistance policy and procedures. Maintains productivity, quality and customer service requirements according to department policy and procedure. Required to obtain and maintain certification as a Certified Transplant Financial Advisor on an annual basis.

Responsibilities and Essential Job Functions

• Ensures the effective financial reimbursement of each transplant patient. Knowledgeable regarding current regulations concerning transplantation financial guidelines to assure maximum reimbursement for patients, physicians, and hospital. Update policies as necessary. Researches latest financial and insurance information.
• Provides comprehensive and ongoing financial counseling to patients. Evaluates and interviews patients, families and providers throughout the transplant and post-transplant processes, including financial screening and financial interview.
• Researches and verifies insurance coverage and limitations. Coordinates resources and possibilities when little or no insurance is available.
• Presents financial profile at evaluation and other pertinent meetings.
• Provides a requirement list to approved candidates of responsibilities, needed deposits or actions, pre-authorizations, pre-certifications etc.
• Provides financial organization and management training and assistance to transplant candidates and their families.
• Determines insurance coverage for immunosuppressive medications and other transplant-related discharge medications.
• Establishes procedures for pre-certification, pre-authorization, forms and letters of medical necessity, including physician visits and outpatient procedures for all transplant patients, both pre- and post-transplant.
• May assist in writing or obtaining letters of medical necessity and associated documents. Sends documents to payors, both public and private. Follow-ups on responses. Provides necessary documentation of coverage and communicate status to appropriate clinical coordinators.
• Facilitates the development of individual case rate agreements with underinsured patients, obtain approval of each case rate from the hospital and involved clinical departments.
• Assists with education of insurance companies on coverage for procedures considered experimental.
• Pre-authorize scheduled transplant evaluations and transplant surgeries.
• Verifies specific coverage for unrelated bone marrow donor searches. Negotiates coverage from insurance to pay as a pass-through or 100% of charges.
• Advises patient of benefits and advise them of financial obligations.
• Helps patient initiate fund raising (KU requires either personal funding or insurance funding to initiate search for donor).
• Registers transplant patient and any donors with appropriate transplant guarantor type. Ensures appropriate guarantor is placed on account as well as appropriate insurance coverage.
• Submits approvals and denials of patients to each transplant program in writing and in accordance with the financial transplant policy.
• Initiates bundled billing episode in accordance with global billing requirements and directs such accounts accordingly.
• Ensures insurance coverage and coordination of benefits are accurate so that reimbursement is maximized and in accordance with all contracts and individual negotiated agreements.
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

• High School Graduate or GED.
• 3 or more years of experience in financial advising, claims processing, collections, customer service, revenue cycle positions that include admitting, patient accounting, prior authorizations, or pre-registration.

Preferred Education and Experience

• 4 or more years of Epic experience.
• 4 or more years of CPT-4 and HCPCS coding experience.

Required Licensure and Certification

• Transplant Financial Advisor Certification within 6 months of employment.

Knowledge Requirements

• Maintain certification on an annual basis.
• Ability to multitask, prioritize, and escalate
• Demonstrated good oral and written skills
• Ability to Typing (45 wpm).
• Working knowledge of CMS regulations.
• Working knowledge of Transplant (BMT and/or Solid).
• Working knowledge of Microsoft (Word and Excel).
• Knowledge of Insurance (Commercial & Government).
• Knowledge of Payor websites.

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.