Transplant Financial Counselor

Primary City/State:
Phoenix, Arizona

Department Name:
Post-Heart Trans-Hosp

Work Shift:
Day

Job Category:
Revenue Cycle

Banner University Medical Center Transplant Institute is Arizona's most experienced transplant center, providing comprehensive care to adult patients in pre and post-transplant acute clinics for heart, lung, liver, and kidney/pancreas transplant, as well as, long term follow up on the transplant recipient. As part of the Banner Health Academic Medical Division we offer Transplant Services in Phoenix and Tucson, AZ. Our Transplant Institute prides itself on delivering compassionate, quality care to our patients and families leading to successful, optimal outcomes.

As the Patient Financial Specialist for the Heart Transplant team, you will have the opportunity to work in a fast paced, multidisciplinary team. In this role, you will be assessing the suitability from a financial perspective of patients considered for therapy, act as a liaison with insurance to obtain authorizations for evaluation, listing and post-transplant services.

This is a full time opportunity. Hours are Monday through Friday, 7AM to 3:30PM.

University Medical Center Phoenix is a nationally recognized academic medical center. The world-class hospital is focused on coordinated clinical care, expanded research activities and nurturing future generations of highly trained medical professionals. Our commitment to nursing excellence has enabled us to achieve Magnet™ recognition by the American Nurses Credentialing Center. The Phoenix campus, long known for excellent patient care, has over 730 licensed beds, several unique specialty units and is the new home for medical discoveries, thanks to our collaboration with the University of Arizona College of Medicine - Phoenix. Additionally, the campus responsibilities include fully integrated multi-specialty and sub-specialty clinics.

POSITION SUMMARY
This position is a UNOS required role as part of the multidisciplinary team that covers all aspects of patient care throughout their evaluation, transplant and post-op care. This position is responsible for verifying patient insurance coverage specific to solid organ trasplant, determining eligibility for financial assistance programs, counseling patients and their family members and communicating with insurance companies and financial aid organizations to secure payment for transplant-related procedures. The position works closely with transplant physicians, social workers, and other healthcare professionals to ensure that patients receive the financial support they need to undergo life-saving transplant surgeries. Additionally, the position partners with hospital billing and reimbursement teams to ensure accurate billing and payment on transplant claims.

CORE FUNCTIONS

1. Acts as an advocate and educator to potential transplant candidates, living donors, caregivers, and family to provide support and anticipate the financial need from the start of evaluation testing through maintaining their transplanted organ post-transplant for the life of their organ. Identifies and anticipates gaps in insurance coverage and identifies resources to bridge those gaps, including pharmacy assistance programs or services and medically necessary services.

2. Performs pre-registration/registration processes. Ensures that all systems have accurate and complete information regarding insurance and billing for transplant vs non-transplant related services. Distinguishes the plan codes for the transplant coverage and the billing process related to each transplant contract. Reviews incoming referrals to the transplant programs to verify that their insurance coverage will adequately cover their care including organ acquisition fees, provider fees, and post-transplant medications. Verifies in/out-of-network coverage and center of excellence requirements with the payer. Obtains minimum requirements of payer to request authorizations for all phases of transplant care.

3. Obtains authorization for all pre-transplant testing, consults, annual testing, transplant procedure and post-transplant care that are required to determine transplant candidacy. Works with insurance case managers to extend authorizations as needed.

4. Counsels every transplant candidate and their caregivers to explain insurance benefits and potential out of pocket costs for the evaluation and waitlist testing as well as for the transplant procedure and post-care including medication coverage and cost. Explains the CMS ESRD coverage for kidney patients with chronic kidney disease including coordination of benefits, Medicare Advantage options and termination of ESRD eligibility.

5. Attends weekly Transplant rounds and selection committee meetings with the full multidisciplinary team to present on patient financial candidacy, risk factors and coverage for additional services. Works with the patient, their insurance, Social Work, and other charitable organizations to mitigate severe financial risk factors that could prohibit transplant.

6. Reports admission for transplant surgery to insurance case managers and documents authorization in all applicable billing systems. Additionally, reports discharge from the hospital after organ transplant to secure post-transplant care authorization. Documents in multiple EMR and billing systems to ensure that the information is available to all involved team members.

7. May provide leadership and training to other members of the financial team and serves as a resource for internal and external customers.

8. Acts as a liaison between patient/PFS department/payer to enhance account receivables performance, resolve outstanding issues and/or patient concerns, and to maximize service excellence.

9. Works independently under general supervision, leads and follows structured work routines. Works in a fast paced, multi-task environment with high volume and immediacy needs requiring independent decision making and sound judgment to prioritize work and ensure appropriateness and timeliness of each patient's care. This position is an integral part of the care team, as they serve as the primary contact for all financial aspects of the patient's care, both for internal and external customers. Internal customers include all levels of the clinical care team, as well as other administrative support positions throughout the facility and organization. External customers include patients and their families, physician office staff and third-party payors.

MINIMUM QUALIFICATIONS

Requires knowledge as typically obtained through an associate's degree, with a focus in healthcare administration or finance.

Requires knowledge of medical terminology and an understanding of all common insurance and payor types, authorization requirements and alternative financial resources as typically obtained through a minimum of three years of diversified experience in a hospital Patient Registration/Financial Services setting.

Requires understanding of Banner's transplant contracts and CMS coverage rules for transplant and organ donation. Requires understanding of the billing process including the systems Banner utilizes for registration and billing for facility and provider claims. This position requires the ability to retain large amounts of changing payor information/knowledge crucial to attaining reimbursement for the services provided.

Ability to complete required tasks while maintaining a big picture view of the patient's transplant process and understanding how each part of the multidisciplinary team may be impacted to provide a full circle of care to every aspect of the patient's needs.

Must have highly developed interpersonal, communications and human relations skills. Must also possess accurate and efficient keyboarding skills, strong organizational and time management skills and flexibility in responding to multiple demands. This role requires critical thinking and decision making to avoid and/or resolve denials, financial hardships, or insufficient coverage for medically necessary treatment.

PREFERRED QUALIFICATIONS

Bachelor's degree in healthcare administration or finance preferred. Prior experience as a financial counselor preferred.

Additional related education and/or experience preferred.

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EEO/Female/Minority/Disability/Veterans

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