- The Transplant Program Financial Manager (TPFM) is responsible for managing the patient financial clearance, insurance verification, pre-registration, quality assurance and education.
- These processes are specifically related to creating a customer friendly environment while securing accurate patient identification, collection of data relating to demographics, insurance and patient safety components.
- Is responsible for ensuring coordination between all pre-service functions, urgent insurance verification, work queue management, quality assurance and staff education.
- Assesses, coordinates and clarifies all patient-specific financial aspects of care for patients and families referred for organ transplantation; to include financial approval, benefit explanation, financial counseling, insurance verification and assuring that proper authorization (initial and subsequent) for prescribed treatment is obtained in a timely manner.
- The TPFM will research the patient’s insurance benefits, annual deductible, co-insurance, co-pays, and out-of-pocket max and current standing for these.
- Offers financial counselling to all patients prior to treatment, which includes outlining and explaining financial obligations and billing processes and establishing payment arrangements with the patients as necessary for the planned treatment and procedures.
- Aids in obtaining financial assistance (for example: drug replacement, foundation assistance, Medicaid), as appropriate.
- This may include a referral to Tower Health vendors to transition the uninsured and underinsured population to sponsorship by identifying sources of coverage through Medicaid, Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), charity care, MarketPlace, and other state and federally funded programs.
- This role requires the use of independent judgment and decision making, it also requires continual attention to the updates in medical policies of the insurance companies and research into new forms of assistance available to the patient population served.
- Adheres to regulations regarding transplantation including but not limited to CMS, UNOS and Joint Commission.
4 year Bachelor's Degree or combination of relevant education & experience may be considered in lieu of Bachelor's Degree