Transplant Financial Coordinator - PFS PASC Authorization ( 1.0FTE, Days )
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Finance & Accounting
1.0FTE, 8-hour Day Shift
At Stanford Children’s Health, we know world-renowned care begins with world-class caring. That's why we combine advanced technologies and breakthrough discoveries with family-centered care. It's why we provide our caregivers with continuing education and state-of-the-art facilities, like the newly remodeled Lucile Packard Children's Hospital Stanford. And it's why we need caring, committed people on our team - like you. Join us on our mission to heal humanity, one child and family at a time.
This paragraph summarizes the general nature, level and purpose of the job.
Under the direction of the Transplant Financial Supervisor, the Transplant Financial Coordinator (TFC) is responsible for providing accurate and professional financial clearance to patients seeking Transplant Services at Stanford Children’s Health. The TFC is responsible for the analysis, validation, and regulatory and compliance activities associated with the financial clearance process. The TFC mitigates the financial risk to Stanford Children’s Health by performing an accurate financial clearance review along with a comprehensive analysis of patient and payer specific benefits and patient liability. Ensures that adequate compensation resources exist and recommends coverage plans that best meet the individuals' needs for evaluation, organ transplantation, and post-operative care. Counsels transplant patients on financial considerations throughout their care experience. Works with a multidisciplinary team consisting of patients, revenue cycle, physicians, nurses, social workers, and pharmacists.
The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned.
Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.
Must perform all duties and responsibilities in accordance with the Service Standards of the Hospital(s).
- Analyze benefit requirements and initiate the request for authorization/prior approval for the 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 treatments
- Analyze benefits for appropriate coverage for services. Review contracts and obtain clarification from managed care contracting and payer coordination as needed
- Meet with patients and family members at the time of transplant evaluation or prior to treatment; inform patients of the anticipated costs of transplant services, the anticipated patient liability, and the patient responsibilities (e.g. post-transplant medications); assist patients with a financial plan when not adequately funded for transplant (e.g. fundraising) or therapy services
- Work with Multidisciplinary team to develop agreements for International, self-funded patients, and patients with limited benefits
- Interact with clinical teams and patient to obtain treatment plans, discharge planning, concurrent and retrospective review, and patient demographics to begin insurance verification process
- Provide ongoing financial counseling based on each individual patient’s benefits, patient financial interview, and calculated estimated expenses based on patient benefits
- Tracks and maintains patient account records of interaction for accurate billing of transplant related services as necessary. Adheres to transplant policies and procedures as related to financial clearance. Coordinates these policies and procedures with those of Patient Financial Services.
- Ongoing financial case management to analyze and review benefits and process patient referrals to external transplant programs as needed
- Resolve any issues related to coverage and payment
Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.
Education: High School Diploma or GED equivalent
Experience: Three (3) years of progressively responsible and directly related work experience
Knowledge, Skills, and Abilities
These are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally demonstrated through qualifying experience, education, or licensure/certification.
- Ability to communicate effectively both orally and in writing
- Ability to maintain confidentiality with sensitive information
- Ability to plan, organize, prioritize, multi-task, and meet deadlines
- Ability to work effectively with individuals at all levels of the organization
- Knowledge of basic mathematics
- Knowledge of computer applications related to patient accounts processing
- Knowledge of medical terminology
- Knowledge of principles and practices of customer service and telephone courtesy
- Knowledge of Windows-based office software, computers and operating systems
Physical Requirements and Working Conditions
The Physical Requirements and Working Conditions in which the job is typically performed are available from the Occupational Health Department. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the job.
Equal Opportunity Employer