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Transplant Financial Coordinator

Company: University of North Carolina Hospitals (Chapel Hil
Location: Chapel Hill
Posted on: June 12, 2021

Job Description:

Job Description Description 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. Job description: 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 DUTIESPatient 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 requested.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 paid.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.Other Information Other information:Education Requirements: Bachelor's degree in an appropriate discipline (or equivalent combination of education, training and experience).Licensure/Certification Requirements: 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:Job Details Legal Employer:STATE Entity: UNC Medical CenterOrganization Unit: Bone Marrow Transplant Program Work Type: Full TimeStandard Hours Per Week: 40.00 Work Schedule: Day Job Location of Job: US:NC:Chapel Hill Exempt From Overtime: Exempt: NoThis is a State position employed by UNC Health Care System.

Keywords: University of North Carolina Hospitals (Chapel Hil, Chapel Hill , Transplant Financial Coordinator, Other , Chapel Hill, North Carolina

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