Manager Prior Authorization Jobs in Raleigh, NC (NOW HIRING)

Description

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Summary:
The Transplant Financial Coordinator (TFC) is responsible for patient financial counseling and clarification of insurance issues to help facilitate access to and provide continuity of care for transplant patients. The Transplant Financial Coordinator achieves this by working with members of the transplant team, insurers and administrative personnel at the Transplant Center.

Responsibilities:
1. Financial Management of Post-Transplant Services - Facilitates resolution of patient billing and insurance issues. Provides financial counseling for patient when needed.
2. Participation on Interdisciplinary Transplant Team--Identifies and effectively communicates financial information to transplant team members with emphasis on patients who do not have adequate coverage. Communicates terms of transplant contracts to transplant team, social worker and pharmacy representative to ensure that patient is receiving care as defined by the contract. Contacts commercial insurance company to verify benefits and obtains prior authorization/pre-certification for the transplant admission. Contacts government insurance agencies to obtain specific guidelines verify benefits and obtain prior authorization for the transplant admission.
3. Patient Counseling and Financial Management of Pre-Transplant Services - Discusses benefits and other transplant financial issues with patient and/or family members with emphasis on the cost of transplantation. Advises patient on how to apply for Medicaid, Medicare and Social Security benefits and other financial programs as applicable. Maintains knowledge of transplant contracts to ensure that contract requirements are met. Identifies and effectively communicates any potential out-of-pocket liability to patients and/or their families. Verifies detailed patient insurance benefit information for all aspects of the transplant process, including but not limited to, outpatient prescription drugs, organ acquisition, living donor coverage, follow-up clinic visits and travel/lodging if necessary. Evaluates insurance status and determines whether COBRA insurance benefits or other financial resources will maximize reimbursement. Provides fund-raising information to patients regarding local and national fund-raising organizations
4. Policy Support - Refines, develops, implements and communicates departmental and health care system policies and procedures to employees, patients and their families. Serves as a resource for employees and management in the interpretation and application of a variety of policies and procedures. Monitors compliance with policies and procedures and makes recommendations for changes as appropriate.
5. Professional Development - Maintains membership with the National Transplant Financial Coordinators Association in order to receive updates on new transplant laws. Takes initiative to attend programs and seminars to maintain and upgrade professional skills and education and also staying abreast of new guidelines pertaining to Medicare, Medicaid and insurance plans.
6. Report Management - Utilizes codes to identify transplant patients in CMS tracking system and insure that correct insurance is on each account in SMS. Determines and assesses if patient?s medical services are transplant related or not and how benefits should be paid.

Other information:
Education Requirements:
Bachelor's degree in an appropriate discipline (or equivalent combination of education, training and experience).
Licensure/Certification Requirements:
No licensure or certification required.
Professional Experience Requirements:
If a Bachelor's degree: Four (4) years of experience in health care operations, including two (2) years of experience with private and federal insurance programs.
If an Associate's degree: Eight (8) years of experience in health care operations, including two (2) years of experience with private and federal insurance programs.
If a High School diploma or GED: Twelve (12) years of experience in health care operations, including two (2) years of experience with private and federal insurance programs.
Knowledge/Skills/and Abilities Requirements:

Legal Employer: STATE

Entity: UNC Medical Center

Organization Unit: Kidney Pre Transplant Program

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: $20.74 - $29.52 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Hybrid

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: No

This is a State position employed by UNC Health Care System with UNC Health benefits. If, however, you are presently an employee of another North Carolina agency and currently participate in TSERS or the ORP, you will be eligible to continue participating in those plans at UNC Health.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email applicant.accommodations@unchealth.unc.edu if you need a reasonable accommodation to search and/or to apply for a career opportunity.