Licensed Clinical Psychologist at Los Angeles General Medical Center / Clinical Assistant Professor of Psychiatry and the Behavioral Sciences (Clinician Educator)

About the role

The Transplant Financial Coordinator Lead works under the direction of the TFC supervisor/manager and fulfills a leadership role over the transplant financial team to ensure transplant patients' medical services are covered by insurance and patients are effectively counseled regarding their insurance plans. The TFC Lead acts as designee of the supervisor/manager to provide team cohesiveness, direction, and education to the transplant financial coordinators, guides/establishes workflow processes to accelerate financial clearance for patients, and streamlines system operations.

Responsibilities

• Acts as leader, mentor, and professional to staff, facilitating positive change, growth, and camaraderie within the department.
• Provides assistance to staff and guides them in organizing daily tasks and resolving challenging financial clearance scenarios.
• Establishes a sense of comradery among peers and with supervisor/lead TFCs to facilitate teamwork throughout the department.
• Works collaboratively to problem-solve, provide coverage when necessary, and assist clinical and non-clinical staff during acute and unforeseen circumstances to advance patient care.
• Self-directs activities and demonstrates an ability to problem-solve and escalate issues as needed.
• Coordinates and clarifies patient-specific insurance and financial aspects of care with less than 5% inaccuracy.
• Obtains and documents detailed patient insurance benefit information, limitations, and exclusions to determine appropriateness for transplantation services and financial criteria of the program, including all aspects of the transplant process: transplant surgery, organ acquisition, follow-up clinic visits, admissions, cost of labs, diagnostic testing, co-payments of outpatient prescription drugs, and travel/housing benefits.
• Discusses benefits and other transplant financial issues with patients and/or family members during initial evaluation, including each time a patient’s insurance coverage changes.
• Serves as a resource for patients and their family members on financial and insurance matters, providing educational materials covering transplant financial benefits, pitfalls, coverage options, and insurance types.
• Works with patients and their families from referral through post-transplantation in a compassionate and tactful manner to facilitate access to and continuity of care.
• Assists patients with questions concerning insurance and other financial issues.
• Proactively guides patients through application processes for government-funded/financial assistance programs (e.g., Medi-Cal, KMC charity program, QMB, Legal Aid, LIS) and coordination of benefits as necessary.
• Works with other members of the transplant team, administrative staff, billing, financial, and clinical personnel to ensure financial coverage of transplant and living donor services.
• Alerts staff to issues impacting a patient’s ability to undergo transplantation.
• Identifies and effectively communicates financial information to transplant team members, patients, and their families, emphasizing potential patient out-of-pocket liability, clearance issues, coverage gaps, and alternate funding options.
• Maintains familiarity with UNOS and CMS regulations related to transplant finance and billing practices.
• Follows KMC and transplant institute policies and procedures, applying financial guidelines, protocols, and policies equally when engaging patients, families, and payors.
• Coordinates recipient and living donor benefits, financial clearance, authorizations, planned surgical events, and clarifies any insurance issues related to living donation.
• Obtains and ensures all necessary payor authorizations, approvals, and clearance, verifying transplant coverage and other medical benefits with less than 5% inaccuracy.
• Acquires necessary referrals/authorizations for planned admission and procedures.
• Assists with financial clearance of urgent inpatient transfers and patients in need of clearance for critical or acute care.
• Routinely monitors insurance coverage for patients throughout all phases of transplant, particularly while patients are waitlisted for an organ.
• Cultivates relationships with insurance case managers and medical directors to facilitate and expedite authorization approvals.
• Retrieves clinical data in a timely manner when requested/required by third-party payers.
• Facilitates resolution of patient billing issues, serving as a liaison to USC Care and Keck billing offices to resolve billing questions and problems.
• Engages non-contracted health plans and medical groups to interface with Keck Hospital and USC Care contracting departments to obtain LOA or other financial guarantees to cover transplant services.
• Participates in weekly transplant selection committee meetings and multidisciplinary clinics to provide financial insurance expertise specific to individual patients and candidates.
• Prepares financial reports for each patient prior to clinic or selection committee to facilitate decision-making for patients and the multidisciplinary team.
• Follows all HIPAA-related compliance by keeping patient clinical/personal information private, including confirming patient identifiers and ensuring HIPAA compliance before sharing information.
• Acts as a business professional in interactions and appearance, providing superior customer service when interfacing with patients, peers, physicians, superiors, and hospital personnel/leadership.
• Represents the transplant department positively and proactively when discussing role and duties.
• Performs other duties as assigned.

Requirements

• High school diploma or equivalent.
• Associate’s degree (AA) required or equivalent experience.
• Minimum of 2–5 years of financial coordination experience, preferably in transplant financial coordination.
• Broad knowledge of health insurance terminology, health insurance processes, and the transplant process.
• Knowledge of transplant database (OTTR), EMR, and various IT systems.
• Demonstrated ability to problem-solve and provide effective resolution.

Preferred Qualifications

• Bilingual strongly preferred.
• Certified Transplant Financial Coordinator (CTFC) strongly preferred.

Required Licenses/Certifications

• Fire Life Safety Training (LA City) – if no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date (required within LA City only).

Pay

The hourly rate range for this position is $29.00 – $45.20. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.