Patient Financial Coordinator - Transplant
Duke University Health System, Durham, NC, United States
At Duke Health, we are driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.
About PRMO
Pursue your passion for caring with the Patient Revenue Management Organization, the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health.
Duke University Health System - Patient Revenue Management Office (PRMO)
seeks to hire a
Patient Financial Coordinator
who will embrace our mission of Advancing Health Together.
The Transplant Financial Coordinator (TFC) is part of a multidisciplinary team charged with providing accurate and professional financial clearance to patients seeking Transplant Services at Duke. The TFC is responsible for verifying demographic and financial information, review and interpretation of insurance benefits, performing financial counseling and financial screening. Establish financial arrangements, refer appropriate cases to other agencies (internal and external) to assist patients with discharge/post hospital care. Interacts closely with Utilization Review and Transplant Billing to ensure correct and timely reimbursement.
In this role you will coordinate administrative services and operations for transplant financial services. Coordination and communication with the patient and clinical team including physicians, nurses, social workers and pharmacists is key for the successful financial analysis and clearance. Attend weekly and monthly required meetings, maintain transplant work queues, and all other tasks and administrative duties as assigned. The Transplant Financial Coordinator has a hybrid schedule Monday through Friday 8:00 am to 4:30 pm, and is part of the Transplant On-call team when scheduled, which includes working after hours remotely Monday through Friday 4:30 pm – 8:00 am, holidays and rotating weekends. Work is performed under the direct supervision of the Transplant Financial Services Supervisor and/or Financial Services Manager with administrative direction provided by the Financial Services Director.
Primary Duties And Responsibilities
Process referrals for transplant evaluation/Insurance Verification/Clinical Coordination
Detailed patient insurance benefit information for aspects of the transplant process including but not limited to outpatient prescriptions, travel and lodging, studies, and fundraising
Review benefits and other transplant financial issues with patients/family members during transplant evaluation
Obtain payer authorizations for transplant evaluation and surgical/waitlist
Coordinate communication between insurance companies, governmental agencies, providers and internal departments
Work with DUHS Finance, Managed Care Contracting, Pharmacy assistance programs in the development of agreements for International, self-funded patients and patients with limited benefits
Interact with Transplant and Oncology Clinical teams (Surgeon, Medical Oncologists, RN Coordinators and Transplant Administration) to obtain treatment plans, discharge planning, concurrent and retrospective review and patient demographics to begin insurance verification process
Interview admitted patients to obtain required information to begin verification
Interact with clinical teams (Surgeon, RN Coordinators and Administration) prior to a patient’s financial clearance, providing key information and data regarding benefits, support and patient financial liability
Prepare financial packets based on each individual patient’s benefits, patient financial interview, and calculated estimated expenses based on patient benefits
Share financial screen daily/weekly with the clinical teams at each of their respective meetings
Notify the patient if not financially approved for evaluation at Duke and redirect these patients to the insurance payer case manager
Data Maintenance And Billing Information (Transplant Specific)
Facilitate resolution of transplant patient billing issues
Utilize clinical and billing knowledge to recognize and resolve billing errors/inconsistencies
Understand federal and state guidelines related to organ transplant
Identify patient in Maestro and accurately identify which guarantor account is to be used for the visit
Update demographic and insurance information in Maestro and the transplant database when informed of changes
Perform a review of each patient visit to determine if a visit was transplant related in order for accurate billing to occur
Communication with the clinicians occurs daily to confirm some visit requirements
Ongoing financial review/analysis, review and analyze patients eligibility, benefit changes and financial status once a patient is accepted for evaluation and through transplant
Patients are followed approximately up to one year post transplant by the Transplant Financial Coordinator
Provide weekend and evening coverage for solid organ transplant referrals to provide timely financial feedback to the surgeons
Patient Identification / Pre-registration
Update demographic and insurance information in Maestro Care
Obtain a Duke Medical Record number for new patients
Analyze benefits for appropriate coverage for services, review contracts and obtain clarification from Managed Care Contracting and Payor Coordination as needed
Resolve Maestro Care alerts for missing or incorrect registration and insurance elements
Add/edit insurance per policy and procedure
Clear TES edits and Hold bills
Obtain authorizations and pre-certifications as required
Work with clinical staff to obtain additional clinical information for benefit review related to clinical trials and off-label drug use
Interview Patients / Provide Financial Counseling
Meet with patients and family members at the time of transplant evaluation or prior to chemotherapy treatment
Inform patients of the anticipated costs of transplant/chemotherapeutic services, the anticipated patient liability, and the patient responsibilities
Assist patients with a financial plan when funds are not adequately available (e.g., fundraising) or therapy services
Implement appropriate collection actions and assist financially responsible persons in arranging payment
Explain billing to patients according to PRMO credit and collection policies
Evaluate patient requests for financial assistance
Notify the Transplant clinical team of financial considerations that prevent or delay listing the patient for transplant
Inform the Oncology Clinical team of financial considerations, seek clinical assistance as needed
Refer patients to Manufacturer Drug programs and Pharmacy Assistance programs as needed for medications
Obtaining Authorization And Prior Approval
Analyze benefit requirements and initiate the request for authorization/prior approval for transplant evaluation, admission, clinic visits, donor compatibility, work-up and testing, organ procurement, and follow-up appointments
Analyze benefit requirements and initiate authorization, pre-certifications and/or pre-determinations for chemotherapy treatments
Work with clinical staff to obtain additional clinical information for benefit review related to clinical trials and off-label drug use
Prepare the medical packet for prior approval, authorization, or pre-certification
Document authorizations in Maestro Care per policy and procedure
Review denials for evaluation and/or transplant and initiate the appeal process with the insurer
Work with oncologists for treatment authorization denials and coordinate with drug manufacturers and payors to obtain coverage
Customer Service
Build rapport with patients and serve as the first point of contact for new transplant candidates
Show knowledge of office/clinic procedures and practices related to the assigned specialty
Screen callers and provide information based on applicable policies and procedures
Triage and respond to calls based on established protocols and standards
Resolve problems or complaints within departmental guidelines
Explain policies and procedures and resolve problems
Gather documentation to support proper handling of inquiries/complaints
Maintain courtesy and professional conduct at all times
Provide timely and effective service to internal customers
Case Management (Transplant)
Set the next review date in the transplant registration screen to trigger the next period of financial verification
Update effective and termination dates of transplant approval when expired
Review outpatient appointments for active transplant patients and resolve coverage/payment issues
Identify operational improvements to maximize efficiency and effectiveness of services
Communicate opportunities to management
Perform other related duties incidental to the work described
Level Characteristics
On occasion overtime or weekend work may be required. Position may be subject to responding to urgent or emergent transplant team requests.
Minimum Qualifications
Education
Experience
High School Diploma required. Advanced degree preferred.
Three years of healthcare experience with a minimum of one year in insurance verification, authorization, or billing experience required. One year of experience with a transplant or chemotherapy program preferred.
Degrees, Licensures, Certifications
Position may be subject to membership with the Transplant Financial Coordinators Association and may be subject to certification with TFCA.
Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation or military status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions
Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
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About PRMO
Pursue your passion for caring with the Patient Revenue Management Organization, the fully integrated, centralized revenue cycle organization that supports the entire health system in streamlining the revenue cycle. This includes scheduling, registration, coding, billing, and other essential revenue functions for Duke Health.
Duke University Health System - Patient Revenue Management Office (PRMO)
seeks to hire a
Patient Financial Coordinator
who will embrace our mission of Advancing Health Together.
The Transplant Financial Coordinator (TFC) is part of a multidisciplinary team charged with providing accurate and professional financial clearance to patients seeking Transplant Services at Duke. The TFC is responsible for verifying demographic and financial information, review and interpretation of insurance benefits, performing financial counseling and financial screening. Establish financial arrangements, refer appropriate cases to other agencies (internal and external) to assist patients with discharge/post hospital care. Interacts closely with Utilization Review and Transplant Billing to ensure correct and timely reimbursement.
In this role you will coordinate administrative services and operations for transplant financial services. Coordination and communication with the patient and clinical team including physicians, nurses, social workers and pharmacists is key for the successful financial analysis and clearance. Attend weekly and monthly required meetings, maintain transplant work queues, and all other tasks and administrative duties as assigned. The Transplant Financial Coordinator has a hybrid schedule Monday through Friday 8:00 am to 4:30 pm, and is part of the Transplant On-call team when scheduled, which includes working after hours remotely Monday through Friday 4:30 pm – 8:00 am, holidays and rotating weekends. Work is performed under the direct supervision of the Transplant Financial Services Supervisor and/or Financial Services Manager with administrative direction provided by the Financial Services Director.
Primary Duties And Responsibilities
Process referrals for transplant evaluation/Insurance Verification/Clinical Coordination
Detailed patient insurance benefit information for aspects of the transplant process including but not limited to outpatient prescriptions, travel and lodging, studies, and fundraising
Review benefits and other transplant financial issues with patients/family members during transplant evaluation
Obtain payer authorizations for transplant evaluation and surgical/waitlist
Coordinate communication between insurance companies, governmental agencies, providers and internal departments
Work with DUHS Finance, Managed Care Contracting, Pharmacy assistance programs in the development of agreements for International, self-funded patients and patients with limited benefits
Interact with Transplant and Oncology Clinical teams (Surgeon, Medical Oncologists, RN Coordinators and Transplant Administration) to obtain treatment plans, discharge planning, concurrent and retrospective review and patient demographics to begin insurance verification process
Interview admitted patients to obtain required information to begin verification
Interact with clinical teams (Surgeon, RN Coordinators and Administration) prior to a patient’s financial clearance, providing key information and data regarding benefits, support and patient financial liability
Prepare financial packets based on each individual patient’s benefits, patient financial interview, and calculated estimated expenses based on patient benefits
Share financial screen daily/weekly with the clinical teams at each of their respective meetings
Notify the patient if not financially approved for evaluation at Duke and redirect these patients to the insurance payer case manager
Data Maintenance And Billing Information (Transplant Specific)
Facilitate resolution of transplant patient billing issues
Utilize clinical and billing knowledge to recognize and resolve billing errors/inconsistencies
Understand federal and state guidelines related to organ transplant
Identify patient in Maestro and accurately identify which guarantor account is to be used for the visit
Update demographic and insurance information in Maestro and the transplant database when informed of changes
Perform a review of each patient visit to determine if a visit was transplant related in order for accurate billing to occur
Communication with the clinicians occurs daily to confirm some visit requirements
Ongoing financial review/analysis, review and analyze patients eligibility, benefit changes and financial status once a patient is accepted for evaluation and through transplant
Patients are followed approximately up to one year post transplant by the Transplant Financial Coordinator
Provide weekend and evening coverage for solid organ transplant referrals to provide timely financial feedback to the surgeons
Patient Identification / Pre-registration
Update demographic and insurance information in Maestro Care
Obtain a Duke Medical Record number for new patients
Analyze benefits for appropriate coverage for services, review contracts and obtain clarification from Managed Care Contracting and Payor Coordination as needed
Resolve Maestro Care alerts for missing or incorrect registration and insurance elements
Add/edit insurance per policy and procedure
Clear TES edits and Hold bills
Obtain authorizations and pre-certifications as required
Work with clinical staff to obtain additional clinical information for benefit review related to clinical trials and off-label drug use
Interview Patients / Provide Financial Counseling
Meet with patients and family members at the time of transplant evaluation or prior to chemotherapy treatment
Inform patients of the anticipated costs of transplant/chemotherapeutic services, the anticipated patient liability, and the patient responsibilities
Assist patients with a financial plan when funds are not adequately available (e.g., fundraising) or therapy services
Implement appropriate collection actions and assist financially responsible persons in arranging payment
Explain billing to patients according to PRMO credit and collection policies
Evaluate patient requests for financial assistance
Notify the Transplant clinical team of financial considerations that prevent or delay listing the patient for transplant
Inform the Oncology Clinical team of financial considerations, seek clinical assistance as needed
Refer patients to Manufacturer Drug programs and Pharmacy Assistance programs as needed for medications
Obtaining Authorization And Prior Approval
Analyze benefit requirements and initiate the request for authorization/prior approval for transplant evaluation, admission, clinic visits, donor compatibility, work-up and testing, organ procurement, and follow-up appointments
Analyze benefit requirements and initiate authorization, pre-certifications and/or pre-determinations for chemotherapy treatments
Work with clinical staff to obtain additional clinical information for benefit review related to clinical trials and off-label drug use
Prepare the medical packet for prior approval, authorization, or pre-certification
Document authorizations in Maestro Care per policy and procedure
Review denials for evaluation and/or transplant and initiate the appeal process with the insurer
Work with oncologists for treatment authorization denials and coordinate with drug manufacturers and payors to obtain coverage
Customer Service
Build rapport with patients and serve as the first point of contact for new transplant candidates
Show knowledge of office/clinic procedures and practices related to the assigned specialty
Screen callers and provide information based on applicable policies and procedures
Triage and respond to calls based on established protocols and standards
Resolve problems or complaints within departmental guidelines
Explain policies and procedures and resolve problems
Gather documentation to support proper handling of inquiries/complaints
Maintain courtesy and professional conduct at all times
Provide timely and effective service to internal customers
Case Management (Transplant)
Set the next review date in the transplant registration screen to trigger the next period of financial verification
Update effective and termination dates of transplant approval when expired
Review outpatient appointments for active transplant patients and resolve coverage/payment issues
Identify operational improvements to maximize efficiency and effectiveness of services
Communicate opportunities to management
Perform other related duties incidental to the work described
Level Characteristics
On occasion overtime or weekend work may be required. Position may be subject to responding to urgent or emergent transplant team requests.
Minimum Qualifications
Education
Experience
High School Diploma required. Advanced degree preferred.
Three years of healthcare experience with a minimum of one year in insurance verification, authorization, or billing experience required. One year of experience with a transplant or chemotherapy program preferred.
Degrees, Licensures, Certifications
Position may be subject to membership with the Transplant Financial Coordinators Association and may be subject to certification with TFCA.
Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation or military status.
Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. All members of our community have a responsibility to uphold these values.
Essential Physical Job Functions
Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.
#J-18808-Ljbffr