Transplant Financial Coordinator

WVU Medicine; Morgantown (WV); On-site; USD 70,000 - 100,000; Full time

Job summary

WVUH West Virginia University Hospitals is seeking a Transplant Financial Coordinator to manage insurance verification, precertification, prior authorization, and financial clearance throughout the transplant journey.

You will collaborate with a multidisciplinary team to uphold protocols of care and ensure accurate transplant billing while assisting patients with financial obligations and payment arrangements.

Qualifications

• Five years of healthcare finance experience or a bachelor’s degree with three years of healthcare finance experience.
• HFMA CRCR certification and TFCA membership are preferred (to be completed as established by department)
• Knowledge of revenue cycle, payers, and EHR requirements.

Responsibilities

• Verify detailed patient insurance benefit information across transplant processes.
• Evaluate insurance status and COBRA or other financial resources to maximize reimbursement.
• Communicate potential out-of-pocket liability to patients and families.
• Obtain prior authorization from commercial and government insurance for transplant services.
• Provide information on local and national fundraising resources to patients.
• Maintain membership with the National Transplant Financial Coordinators Association.
• Assess transplant-related services for coverage and payment.
• Review self-pay donor statements for Medicare compliance.
• Attend weekly transplant department meetings.
• Demonstrate mature problem-solving and conflict management with patients and teams.

Skills

Excellent written and communication

Interpersonal communication

Analytical and problem solving

Multitasking in fast-paced environment

Independent project work

Excel and Access proficiency

Knowledge of payer regulations

Education

Bachelor's degree in business/health information/related

High school diploma or equivalent

Tools

Microsoft Excel

Microsoft Access

Job description

The Transplant Financial Coordinator is an advanced level position, responsible for resolving referral, precertification, prior authorization, and financial clearance beginning with the evaluation for transplantation and continuing through the post‑transplant process. This includes participation and collaboration with a multidisciplinary team in the development and implementation of protocol and standards of care planned for the transplant patient. Assist in transplant financial vitality by reviewing accounts to ensure appropriate billing for transplant related services. Courteously and professionally work with patients to outline financial obligations related to care, and provide options for patients to meet financial requirements, including assessing financial assistance eligibility, determining insurance coverage eligibility, establishing payment arrangements, collecting preservice payments and co‑payments as needed.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

• High school diploma or equivalent

EXPERIENCE:

• Five (5) years of healthcare finance experience or bachelor’s degree with three (3) years of healthcare finance experience.

To be completed as established by department: (Administered at Department level)

• CRCR certification through Healthcare Financial Management Association (HFMA
• Transplant Financial Coordinators Association (TFCA) membership.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

• Bachelor’s degree in business, health information, or related field

EXPERIENCE:

• Five (5) years of financial counseling experience
• Revenue cycle experience

CORE DUTIES AND RESPONSIBILITIES:

The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

• Verify detailed patient insurance benefit information for all aspects of the transplant process, including but not limited to outpatient prescription drugs, living donor coverage, follow-up clinic visits, and travel/lodging if necessary.
• Evaluate insurance status and determine whether COBRA insurance benefits or other financial resources will maximize reimbursement.
• Identify and effectively communicate any potential out‑of‑pocket liability to patients and/or their family.
• Contact commercial insurance companies to verify benefits and obtain prior authorization for transplant services.
• Contact government insurance agencies to verify benefits and obtain prior authorization for transplant services.
• Provide fund‑raising information to patients regarding local and national fund‑raising organizations.
• Maintain membership with the National Transplant Financial Coordinators Association to receive updates on new transplant laws.
• Determine and assess if patients’ medical services are transplant related and how benefits should be paid.
• Review account claim errors pre‑billing related to registration for all transplant related account to review for coordination of benefits, payer, and patient demographic accuracy to ensure prompt payment.
• Review all self‑pay donor statements to ensure correct billing to maintain Medicare regulation compliance.
• Attend weekly departmental transplant meetings to discuss current and potential transplant patients.
• Project a mature problem‑solving response while dealing with interpersonal conflict, medically compromised individuals, dissatisfied patients, and stringent time demands.

PHYSICAL REQUIREMENTS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to sit for long periods of time.
• Ability to lift, push or pull 10–15 pounds.

WORKING ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Standard office/clinic environment.

SKILLS AND ABILITIES:

• Excellent written and communication skills
• Oral and written communication ability to effectively represent the department and Hospital in interactions with third party payers, patients, physicians, and other departments. Ability to explain this analysis to a non‑technical audience of both internal and external customers, including executive management.
• Analytical and problem‑solving skills as well as the ability to work and communicate effectively with other departments.
• Ability to manage multiple tasks and projects in a fast‑paced environment and forge strong interpersonal relationships within the department and with other departments
• Ability to work independently on projects and add measurable value to the organization.
• Extensive knowledge of personal computers and Microsoft Excel and Access software preferred.
• Demonstrates knowledge of third‑party payer regulations, revenue cycle functions, and electronic health records requirements.
• Maintains current knowledge of performance improvement processes as it applies to health care.

Additional Job Description:

Scheduled Weekly Hours:

40

Exempt/Non-Exempt:

Shift: United States of America (Non-Exempt)

Company:

WVUH West Virginia University Hospitals

Cost Center:

7850 WVUH Transplant Admin

Address:

1 Medical Center Drive Morgantown West Virginia

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.