The Transplant Financial Coordinator (TFC) is a designated member of the multidisciplinary transplant team and is responsible for providing financial services to the various solid organ transplant programs. The position is responsible for obtaining medical and financial authorization for transplant patients in the various stages of the transplant process. This begins with meeting and counseling the patient at the transplant evaluation visit. Provides insurance verification, medical benefit analysis with respect to transplantation, including benefits for pharmaceuticals. Assesses patient’s financial ability to support all phases of transplant case, including post-transplant immunosuppression therapy and transplant related medical procedures. Serves as a financial resource to the patient, their families and/or designee and provides ongoing financial counseling and education as necessary. Provides transplant team assessment of patient’s medical insurance and help coordinate care with the insurance carrier to maximize potential benefits.
- Identifies and effectively communicates financial information to transplant team members, patients and their families with emphasis on identifying any potential patient out-of-pocket liability. Establishes relationships with insurance company case managers and medical directors to facilitate insurance approvals.
- Obtains all necessary payor authorizations. Verifies transplant coverage and other medical benefits and acquiring necessary referrals and authorizations for inpatient stays and procedures. Assists with financial clearance of urgent inpatient transfers of critical patients. Monitors insurance coverage for patients throughout the period that they are waiting for a transplant.
- Works with patients, their families and team members when possible to help address insurance coverage gaps via alternative funding options.
- Facilitates resolution of patient billing issues. Serves as a liaison with the professional fee and hospital billing offices to resolve billing questions and issues.
- Obtains and documents detailed patient insurance benefit information for all aspects of the transplant process, including, but not limited to, transplant surgery, outpatient prescription drugs, organ acquisition, follow-up clinic visits, and travel and housing if necessary.
- Collaborates with the Managed Care Department to obtain single case agreements, or other arrangements with patient insurance companies, in order facilitate transplant coverage.
Assists hospital claims department with proper identification of and accounting for global contract cases.
- Participates in a rotating on call schedule with other TFCs to provide urgent inpatient transfer and/or transplant authorization support on weekends if necessary.
Education or Equivalent Experience:
H.S. Diploma/GED (Required)
Minimal of 4 years’ experience in a medical setting either hospital based or large physician practice Experience Hospital and Physician billing and strong medical insurance knowledge Transplant Financial Coordination or Pre-certification experience preferred
To apply for this job please visit careers.pennmedicine.org.