Transplant Financial Counselor

Title:Cellular Therapy / Transplant Financial Counselor
Location: Remote 
Type: Contract to hire
Compensation: $22.00-$24.00
 

POSITION SUMMARY:

The Transplant Counselor is responsible for coordinating all financial phases of a transplant procedure. This will also include a detailed review of insurance benefits covering transplant and Immune Effector Cell services, coverage maximums and limitations, patient financial responsibility, and confirming other benefits ancillary to the transplant and IEC (i.e., dental coverage, home healthcare, rehab, retail pharmacy coverage, travel and lodging benefits).  The Transplant Counselor is responsible for securing all required referrals/authorizations for each phase of the transplant and IEC prior to the services performed.  The Financial Counselor is responsible for effectively communicating the patient’s financial status with the Clinical Team at each phase and working with the Clinical Team to escalate referrals/authorizations and coverage issues or temporarily defer the start of a phase. 

PRIMARY DUTIES AND RESPONSIBILITIES:

• Accepts transplant and IEC team assignments from the Transplant Team and begins the detailed review of transplant and Immune Effector Cell (IEC) benefits, including preparing the Transplant and IEC Patient Introduction Letter and updating and completing registration.
• Verifies eligibility and coverage for transplant and/or IEC services.  Pursues insurance approvals and coverage by submitting medical documentation required for referral/authorization at each phase of the transplant and IEC, including IEC and transplant evaluation, donor search, workup, and post-transplant and IEC follow-up care.   
• Acts as the liaison for the insurance Case Manager/Medical Director and patient.
• Participates in weekly Clinical Team meetings and communicates the patient’s financial clearance status necessary to assist with clinical decision making.  Coordinates with patient/provider in appealing denied services, including coordinating peer-to-peer conferences.
• Serve as a resource to patients, families, and staff regarding transplant and IEC financial issues through policy explanations, financial assistance program discussions, and application assistance.
• Prepare Financial Waivers and Advanced Beneficiary Notices (ABN) for patients with insurance plans that may not cover transplant or IEC services.
• Complies with all transplant and IEC billing practices, including updating the appropriate billing plans in the Hospital Information System as well as updating third-party websites with clinical dates and submission of administrative documents required by payers at time of admission.
• Performs review of each patient visit to determine if the visit was transplant-related for accurate billing to occur. 
• Documents all patient account correspondence in the appropriate note field, designated forms, or databases; this includes all phone calls incoming and outgoing, referral/authorization number data, and any other account knowledge that becomes available.
• Completes assigned work queues, projects, and other duties as needed. 

QUALIFICATIONS:

•  Bachelor’s degree preferred.
• 2 years of relevant work experience in a hospital or ambulatory setting, including hospital/physician office registration, financial counseling, and billing experience.
• Knowledge of insurance coverage verification, detailed benefit investigation, or clinical authorizations.
• Extensive knowledge and comprehension of ICD-10 and CPT coding, medical terminology, or insurance standards and regulations is a plus.
• Strong knowledge of managed care policies and medical terminology. 
• Strong knowledge and understanding of prior authorization and billing practices.
• Strong knowledge and understanding of the bone marrow transplant and IEC process and related billing practices. 
• Knowledge of hematology/oncology and/or cellular therapy services is preferred.
• Excellent customer service and communication skills.
• Strong analytical problem-solving skills and mathematical/accounting skills.
• Superior technical skills with experience with Microsoft Office and Epic.
• Ability to prioritize and meet predetermined deadlines.
• Ability to develop and maintain relationships with the clinical teams, case managers, and other contacts.

If you are interested in this opportunity, please send your resume to pkulturides@daleyaa.com or apply to this opportunity. 


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