Kidney Transplant Financial Manager at Boston Medical Center

POSITION SUMMARY:The Kidney Transplant Financial Manager serves as the primary point person for all financial planning for BMCs pre and post-kidney transplant patients. The individual is responsible for obtaining patient insurance benefit and financial information in order to provide comprehensive insurance option counseling that will optimize patients access to and coverage of transplantation services. The Kidney Transplant Financial Manager will serve as a committee member on the Multidisciplinary Kidney Transplant Listing Meeting and is responsible for overseeing that appropriate authorizations are obtained and documentation is prepared to allow for appropriate listing to the organ-offer wait-list. The candidate will also be responsible for reviewing all charges both inpatient and outpatient on all transplant accounts to ensure they are processed correctly and in compliance with regulatory agencies. Additionally the Kidney Transplant Financial Manager will be the primary financial monitor for the Center for Medicare Services United Network for Organ Sharing and New England Donor Services financial policies and work with kidney transplant staff and the hospital finance staff to ensure understanding and compliance of guidelines and regulations. The individual will assist surgery leadership and hospital finance leadership with transplant financial projects from start to finish participating in multi-professional working groups focused on improving the financial journey of kidney recipients and living donors through the kidney transplantation program at BMC.Position: Kidney Transplant Financial ManagerDepartment: Kidney Transplant ClinicSchedule: Full TimeESSENTIAL RESPONSIBILITIES / DUTIES:The Financial Manager supports the Division of Kidney Transplantation within the Department of Surgery.Financial GuidanceMeets with potential transplant patients to assess financial means and needs and provide financial information and resources as needed. Assists with financial planning.Obtains detailed patient insurance benefit information and assists with verification of coverage relating to all aspects of the transplant process including but not limited to: evaluation transplantation outpatient prescription drug benefits post-transplant services out-of-pocket maximums and travel and housing if necessary. Determines co-payment expectations and other potential out-of-pocket liability.Serves as a resource for patients and family members on financial matters throughout the transplant process. Works with patients their families and transplant team members to address insurance coverage gaps and issues and investigates alternative funding options as necessary.Advises transplant candidates on insurance and funding options including providing information regarding alternate funding and choices of insurance coverage i.e. Medicare and Medicaid eligibility COBRA Social Security Disability retirement plans etc. Provides information to patients regarding available medication assistance programs and assistance with co-payments and organizations that can assist with fund-raising. Assists with applications eligibility guidelines and other necessary paperwork or process issues to access such assistance.Financial Reporting Committee Member Participates in transplant program multi-disciplinary and/or other patient management meetings and is prepared to provide pertinent financial information.Ensures that all necessary payer authorizations are obtained prior to listing verifies transplant coverage and other medical benefits as needed for pre/post-transplant and living donor patients prior to services rendered.Keeps clinical staff informed of all patient financial information and alerts staff to any issues that may impact patients ability to undergo services during the transplantation process.Serves as a routine resource to the Transplant team and provides explanation to the clinical and administrative staff in regard to transplantation reimbursement criteria and insurance coverage.Management Implements policies to meet transplant financial regulatory requirements in accordance with Medicare/ Medicaid and UNOS guidelinesUphold these regulatory policies by educating transplant and hospital staff with the ability to identify non-compliance and provide solutions for teams to meet regulation requirementsLeads projects related to transplant financials from inception to completionManage working groups with multi-professional teams including epic/ phoenix analysts revenue cycle accounts payable and reimbursement teamsProvide content expertise for transplant billing and charge coordination for hospital billing and professional billing teamsEffectively research Medicare and Medicaid regulatory requirements and insurance payor contracting requirements and stay up-to-date on legislation changes that impact these regulationsAttends local national and international meetings and conferences to remain current regarding issues relevant to the performance of transplant financial duties.Performs other duties as assigned or as needed.Billing and Charge CoordinationWorking with division staff and finance/billing staff facilitates resolution of patient billing issues.Responsible for managing the account review charge router and organ acquisition work queues in EPIC.Ensures patient registration is entered accurately and according to CMS rules for payment of transplant and live donor servicesReviews all hospital facility charges and professional fees to ensure payment by appropriate entity; hospital or transplantReimbursementThe Financial Manager collaborates with the hospital finance department to ensure that all appropriate transplant costs are entered in the Medicare Cost Report to optimize reimbursement activitiesOversees collection of Medicare Cost Report time study data one week per month from all staff and providers involved with pre- and post-transplant services.Must adhere to all of BMCs RESPECT behavioral standards.(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).JOB REQUIREMENTSEDUCATION:Bachelors Degree with preference for concentration in Economics Business Accounting or Finance.Significant directly relevant experience will be considered in lieu of degree.CERTIFICATES LICENSES REGISTRATIONS PREFERRED:Transplant Financial Coordinator CertificateCertified Professional BillerEXPERIENCE:Minimum of 2 years direct experience with healthcare insurance benefits preferably in a hospital settingExperience with transplant systems i.e. Epic Phoenix UNOS is a strong plusExperience with healthcare regulatory agencies (Medicare/ Medicaid)and compliance reporting is a strong plusExperience leading teams with projects is a strong plusDemonstrated strong experience working effectively with patients doctors and nurses.KNOWLEDGE AND SKILLS:Must be able to interpret state and federal policy guidelines and educate others on policy regulations in an effective mannerMust have the ability to work independently follow up on tasks and use good judgmentMust be a team player and enjoy working with people both on the telephone and in-person; ability to deal effectively with difficult people.Excellent interpersonal and communication (oral written e-mail grammar) skills necessary.Excellent computer skills; proficient with Microsoft Word Excel Visio Zoom.Compensation Range:$72500.00- $105000.00This range offers an estimate based on the minimum job qualifications. However our approach to determining base pay is comprehensive and a broad range of factors is considered when making an offer. This includes education experience skills and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs internal equity and addition BMCHS offers generous total compensation that includes but is not limited to benefits (medical dental vision pharmacy) discretionary annual bonuses and merit increases Flexible Spending Accounts 403(b) savings matches paid time off career advancement opportunities and resources to support employee and family well-being.NOTE: This range is based on Boston-area data and is subject to modification based on geographic location.Equal Opportunity Employer/Disabled/VeteransAccording to the FTC there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not ask or require downloads of any applications or apps job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.Required Experience:Manager Key Skills B2B Sales,Arabic Speaking,Adobe Flash,Executive Support,BI Employment Type : Full-Time Experience: years Vacancy: 1 Monthly Salary Salary: 72500 - 105000