Under the direction of the TFC supervisor, the transplant financial coordinator (TFC) is a designated member of the multidisciplinary transplant team. His/her primary function is to assure transplant patients’ medical services are covered by insurance. This includes: insurance verification, authorization submission, effective patient counseling of insurance plans, providing insurance guidance when patients have a lapse of insurance or are under-insured and solid understanding of the complexity of transplant benefits as dictated by different insurance coverage. S/he is responsible for accelerating patient financial clearance by following standardized process steps. The TFC is also expected to problem-solve in real time and provide appropriate insurance direction to patients and staff, as needed. The TFC will participate in team meetings and discussions related to complex cases, advancing operational throughput and process improvement to benefit patient care. S/he should possess analytic skills and be able to evaluate/analyze insurance information to effectively convey and communicate to others. S/he should have excellent verbal and written skills and an ability to easily learn hospital and transplant IT systems as they relate to financial clearance and insurance. Bilingual fluency is strongly preferred.
- Responsible for coordinating and clarifying patient-specific insurance and financial aspects of care with less than 5% inaccuracy.
- Work with patients and their families from referral through post-transplantation in a compassionate and tactful manner, in order to help facilitate access to, and provide, continuity of care. Assist patients with questions concerning insurance and other financial issues. Work with other members of the transplant team, administrative staff, billing, financial and clinical personnel at KMC to ensure financial coverage of transplant and living donor services. Alert staff to issues impacting a patient’s ability to undergo transplantation.
- Obtain and document detailed patient insurance benefit information, limitations and exclusions to determine appropriateness for transplantation services and financial criteria of program, including, but not limited to, all aspects of the transplant process: transplant surgery, organ acquisition, follow-up clinic visits, admissions, cost of labs, diagnostic testing, co-payments of outpatient prescription drugs and travel/housing benefits. Discuss benefits, and other transplant financial issues, with patients and/or family members during initial evaluation, including each time a patient’s insurance coverage changes.
- Serve as a resource for patients and their family members on financial and insurance matters. Provide patients with educational materials, which cover transplant financial benefits and pitfalls, coverage options and insurance types.
- Obtain all necessary payor authorizations, approvals and clearance. Verify transplant coverage and other medical benefits. Acquire necessary referrals/authorizations for planned admission and procedures with less than 5% inaccuracy. Assist, as needed, with financial clearance of urgent inpatient transfers and patients in need of clearance for critical or acute care.
- Routinely monitor insurance coverage for patients throughout all phases of transplant, particularly while patients are waitlisted for an organ. Cultivate relationships with insurance case managers and medical directors to facilitate and expedite authorization approvals. Retrieve clinical data in a timely manner when requested/required by third party payers.
- Identify and effectively communicate financial information to transplant team members, patients and their families with emphasis on identifying any potential patient out-of-pocket liability, clearance issues, coverage gaps and alternate funding options. Proactively guide patients through application processes for government funded/financial assistance programs (i.e. Medi-Cal, KMC charity program, QMB, Legal Aid, LIS, etc.) and coordination of benefits as necessary.
- Facilitate resolution of patient billing issues. Serve as a liaison to USC Care and Keck billing offices to resolve billing questions and problems.
- Maintain familiarity with UNOS and CMS regulations related to transplant finance and billing practices. Follows KMC and transplant institute policies and procedures. Apply financial guidelines, protocols and policies equally when engaging patients, families and payors.
- Work with clinical staff to coordinate recipient and living donor benefits, financial clearance, authorizations, planned surgical events and clarify any insurance issues related to living donation.
- Participate in the weekly transplant selection committee meetings and multidisciplinary clinics to provide financial insurance expertise specific to individual patients and candidates. Prepare financial reports for each patient prior to the clinic or selection committee to best facilitate decision-making for patients and the multidisciplinary team.
- Engage non-contracted health plans and medical groups to interface with Keck Hospital and USC Care contracting departments to obtain LOA, or other financial guarantees, to effectively cover transplant services from a fiduciary standpoint.
- Follow all HIPAA related compliance by keeping patient clinical/personal information private. This includes, but is not limited to: Confirming a minimum of two patient identifiers prior to discussions with patients and staff, sending written or electronic communications and/or entering new information into electronic systems. Prior to speaking with any patient representatives confirm the representative is noted in the EMR, or transplant EMR, to receive HIPAA related information. If a HIPAA violation occurs, communicate immediately with a supervisor, quality department representative and enter the violation into the risk management system.
- Act as a business professional in interaction and appearance by providing superior customer service when interfacing with patients, peers, physicians, superiors and hospital personnel/leadership. Represent the transplant department in a positive and proactive way to others when discussing role and duties.
- Establish a sense of comradery among peers and with supervisor/lead TFCs to facilitate teamwork with others and throughout the department. Work well with others to problem-solve, provide coverage when necessary and assist clinical and non-clinical staff during acute and unforeseen circumstances to advance patient care.
- Perform other duties as assigned.
- Req High school or equivalent
- Req Associate’s degree Degree in a related field
- Req Content knowledge of medical terminology and transplant process preferred. Ability to become proficient in EMR and various IT systems required.
- Req Demonstrated ability to problem-solve and provide effective resolution.
- Pref Bilingual strongly preferred; if bilingual certified department translator strongly preferred.
- Pref Bachelor’s degree Degree in a related field
- 2 years transplant financial experience may substitute for minimum education
- Pref 2 years Experience in the medical field, including transplant and transplant finance preferred.
- Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)
The hourly rate range for this position is $22.00 – $34.18. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.
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