LEAD TRANSPLANT FINANCIAL SPLST at H. Lee Moffitt Cancer Center – Tampa, Florida

A Lead Transplant Financial Specialist at Moffitt Cancer Center is responsible for analyzing clinical orders and researching complex insurance coverage information to develop financial/payment expectations for prospective Bone Marrow Transplant patients, donors and families. A Bone Marrow Transplant is a complex and high-cost procedure that results in a need for long term medical care. Patients and families need extensive financial counseling to make an informed decision about the Transplant process.

The Lead Transplant Financial Specialist is responsible for verification of insurance benefits (including carve-outs and special contracts), developing detailed estimates for the patients including out of pocket expenses during the transplant and consideration of long-term non hospital expenses including prescription drug coverage and other personal expenses. Acquiring referrals and authorizations for all services within this treatment series, while communicating regularly with clinical teams and patients throughout the entirety of the process.

The Lead Transplant Financial Specialist is responsible for comprehending and consistently working all job functions of the team and is a subject matter expert for the team, providing guidance to fellow team members based on experience and knowledge. A Lead Transplant Financial Specialist steps in and helps fill team gaps and takes on additional tasks from management to aid in team productions and quality assurance.

Attention to detail is critical, reviewing each patient’s treatment plan and insurance benefits to ensure that all information is accurate, and that pre-certification or authorization is obtained from the payor and/or primary care physician. High levels of focus, critical thinking, and time management are needed to meet performance goals.

Successful Transplant Financial Specialists have strong computer and software navigation skills, are comfortable with medical terminology, this includes comprehension and research of clinical information, are organized and thrive in a highly structured environment. Supporting the unique needs of cancer patients, Transplant Financial Specialists must remain calm under pressure and work comfortably with tight deadlines and competing priorities. Members of the team work independently but are flexible and collaborate to ensure that the department’s goals are met.

Financial counseling provided by the Transplant Financial Specialist may occur by phone communication or by email communication. Therefore, the Transplant Financial Specialist must have strong verbal and written communication skills and be comfortable providing customer service via these technology outlets. Due to the complexity these patients face, the specialist must offer an abundance of compassion and patience, creating not only a financial guide for the patient but also a line of support system as well while fassisting patients through this journey from a financial perspective.

Responsibilities:

Insurance verification and benefits

• Accurately capture information / document in the registration system the correct payor and health plan, procedure and diagnosis codes and identification numbers.
• Comprehension of correct insurance policies to select along with accurate coordination of benefit knowledge
• Communicate with ordering providers, all clinic personnel, patients and insurance company representatives to obtain and share regular status updates and acquire needed benefits from health plans to relay to clinic and patients. Includes verbal and written (email, online or fax) communication.
• Understand and determine clinical trials associated with or without transplant cases. Acquire clinical trial benefits and servicea pprovals via insurance companies alongside transplant benefits and approvals.
• Be well versed in benefits and approval obtainment for all service types provided within Moffitt
• Understand benefit caps, insurance carve outs, service specific coverages, and patient financial responsibilities
• Research and comprehend clinical documentation to capture accurate and necessary clinical information for health plan
  coverage
• Regularly update the supervisor, patient and clinic on challenges obtaining information related to benefits.
• Provide issue resolution (first level of escalation) for customers and patients and refer issues to supervisors when further escalation is indicated.
• Provide coverage for other team members when applicable

Estimates/Collections

• Provide estimates for uninsured patients and provide financial guidance for under insured patients along with insured patients.
• Develop detailed estimates of coverage for Bone Marrow Transplant patients, donors and families.
• Discuss with families to review estimates and ensure understanding of the financial obligations incurred with a BMT.
• Has detailed discussions with patients and families, both by phone and/or email regarding benefits and financial obligations.
• Field and answer financial queries from patients, donors and clinic

Referrals/Authorizations

• Request and obtain referrals from PCP offices if applicable
• Request and obtain authorizations for all phases of treatment, including all services to be completed in the future for specified care
• Open cases with insurance nurse case managers for ongoing authorizations and updates throughout the entire treatment
• Provide continuous updates to clinic and patient throughout the process
• Status check all requests with health plans regularly until completion
• Research and submit specific clinical records to insurance companies
• Answer clinical questions to health plans and nurses for financial review
• Provide coverage for other team members when applicable
• Escalates/Delegates clinical items to nursing team, clinic and/or management
• Assist in orienting and training new team members and serve as a new hire resource.
• Understand and work concomitantly with automation functions within the workload
• Develop strong relationships with clinical staff and patients during the extended treatment process
• Navigate clinical trial road maps and billing discrepancies to decipher revenue source

Lead

• The Lead will be responsible for mentoring and training less experienced team members. This role will assist the Supervisor and/or Manager with ensuring operational quality and productivity is maintained according to dept standards, tracking trends and recommending improvements. The lead is responsible for providing guidance to fellow team members and filling in the gaps on the team when needed. The lead is responsible for maintaining fluent knowledge of all teamwork functions and process to assist when applicable. The lead is a subject matter expert who will share knowledge and help the team regularly.

Other Duties as assigned

• Other tasks assigned by supervisor

Credentials and Qualifications:

• High School Diploma/GED
• Minimum of six (6) years’ experience in data processing, hospital registration, insurance verification and insurance pre- certification/authorization with a healthcare provider or insurance company required, inclusive of 2 years of BMT authorization experience.
  • or
    • Associates Degree and four (4) years experience in data processing, hospital registration, insurance verification and insurance pre-certification/authorization with a healthcare provider or insurance company required, inclusive of two (2) years of BMT authorization experience

• **Certified Revenue Cycle Representative (CRCR) must have within 6 months of hire and renewal is not required. Certification will be tracked by the business.