Workplace: The Bone Marrow Transplant and Cellular Therapy
Program (BMTCTP) is an integrated workforce that consists of
clinical, collection and processing teams. Our vision is to be the
leading provider of bone marrow transplant and cellular therapies
for cancer and blood disorders through compassionate patient &
family-centered care informed by discovery and innovative clinical
treatments. We utilize common staff training, protocols, Standard
Operating Procedures, quality management systems, clinical outcomes
analysis and regular interaction with ancillary departments with
whom we partner to provide exceptional care.
The Transplant Financial Coordinator (TFC) is an integral member
of the multi-disciplinary team and is responsible for patient
financial counseling and clarification/coordination of insurance
issues to facilitate access to transplant & CAR-T services and
provide continuity of care for this patient population. The TFC
achieves this by working with patients and families, members of the
adult transplant team/providers, the pediatric team/providers,
insurers, research coordinators, administrative personnel, Patient
Accounts and the Oncology Finance and Managed Care Departments.
DESCRIPTION OF DUTIES
Patient Counseling and Financial Management of Pre-Transplant or
CAR-T Services-Obtains verification of coverage prior to
consultation, discusses benefits and other financial issues with
patient and/or family members with emphasis on the cost of
transplantation. Submits medical necessity request and obtains
authorization for the transplant or commercial CAR-T event from the
payer. Advises patient on how to apply for Medicaid, Medicare and
Social Security benefits and other financial programs as
applicable. Maintains knowledge of transplant contracts to ensure
that contract requirements are met. Identifies and effectively
communicates any potential out-of-pocket liability to patients
and/or their families. Verifies detailed patient insurance benefit
information for all aspects of the transplant or CAR-T process,
including but not limited to, outpatient prescription drugs, donor
coverage, follow-up clinic visits and travel/lodging benefits.
Evaluates insurance status and determines whether COBRA insurance
benefits or other financial resources will maximize reimbursement.
Contacts government insurance agencies to obtain specific
guidelines verify benefits and notifies team of documentation
requirements for enrollment on required CMS studies for Medicare
recipients to ensure reimbursement.
Patient Counseling and Financial Management for Clinical Trials
& Commercial CAR-T therapies - Obtains verification of clinical
trials benefits and authorization for medical necessity prior to
enrollment on any trials concurrent to the bone marrow transplant
event. Obtains verification of clinical trials benefits and
authorization for medical necessity for all CAR-T research trial
candidates including authorization for consultation, collection,
lymphodepletion and admission or infusion of manufactured product
in the OP setting.
Participation on Interdisciplinary Transplant & CAR-T Teams --
Identifies and effectively communicates financial information to
the separate transplant and CAR-T teams with emphasis on patients
who do not have adequate coverage. Communicates terms of transplant
contracts to transplant team, social worker and pharmacy to ensure
that patient is receiving care as defined by the contract. Contacts
commercial insurance company to verify pharmacy benefits vs.
confirms enrollment in Part D Medicare for OP pharmacy benefits if
Medicare primary. Attends weekly BMTCT Pediatric Team Meeting,
weekly Adult/Pediatric BMTCT Team Meeting, weekly CAR-T Financial
Meeting, bi-monthly CAR-T Pod meeting and other meetings as
Financial Management of Post-Transplant Services-- Facilitates
resolution of patient billing and insurance issues. Provides
financial counseling for patient when needed.
Account Management-- Utilizes codes to identify transplant
patients in CMS tracking system and ensure that correct insurance
is on each account in Epic including transplant guarantor status
for proper billing. Determines and assesses if patient's medical
services are transplant related or not and how benefits should be
Donor Services - Point of contact for testing from 3rd party
vendors for related donors. Monitors donor charges for procurement
and ascertains charge is placed after cells are infused; manages
HLA Testing Requests bi-weekly from the UNC Transplant Laboratory
by designating a "proceed" vs. "hold" vs. "extract and hold" status
for any HLA testing ordered throughout the HCS. Monitors related
donor guarantor remains the recipient during donation period.
Policy Support-- Refines, develops, implements and communicates
departmental and health care system policies and procedures to
employees, patients and their families. Serves as a resource for
employees and management in the interpretation and application of a
variety of policies and procedures. Monitors compliance with BMTCT
Program financial policies and procedures and makes recommendations
for changes as appropriate.
Bachelor's degree in an appropriate discipline (or equivalent
combination of education, training and experience).
No licensure or certification required.
Professional Experience Requirements:
If a Bachelor's degree: Four (4) years of experience in health
care operations, including two (2) years of experience with private
and federal insurance programs.
If an Associate's degree: Eight (8) years of experience in
health care operations, including two (2) years of experience with
private and federal insurance programs.
If a High School diploma or GED: Twelve (12) years of experience
in health care operations, including two (2) years of experience
with private and federal insurance programs.
Knowledge/Skills/and Abilities Requirements:
Legal Employer: STATE
Entity: UNC Medical Center
Organization Unit: Bone Marrow Transplant Program
Work Type: Full Time
Standard Hours Per Week: 40.00
Work Schedule: Day Job
Location of Job: US:NC:Chapel Hill
Exempt From Overtime: Exempt: No