Authorization Appeals - Stem Cell Transplant

About City of Hope,
City of Hope's mission is to make hope a reality for all touched by cancer and diabetes. Founded in 1913, City of Hope has grown into one of the largest and most advanced cancer research and treatment organizations in the U.S., and one of the leading research centers for diabetes and other life-threatening illnesses. City of Hope research has been the basis for numerous breakthrough cancer medicines, as well as human synthetic insulin and monoclonal antibodies. With an independent, National Cancer Institute-designated comprehensive cancer center that is ranked top 5 in the nation for cancer care by U.S. News & World Report at its core, City of Hope’s uniquely integrated model spans cancer care, research and development, academics and training, and a broad philanthropy program that powers its work. City of Hope’s growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and cancer treatment centers and outpatient facilities in the Atlanta, Chicago and Phoenix areas.

The successful candidate:

Hours: Mon - Fri 8am - 5pm (occasional extended hours maybe needed)

Location: Newnan, GA.

This is not a remote position. Must be able to work onsite

JOB SUMMARY

The Cellular Therapy Finance Specialist is responsible for the front-end verification of patients’ transplant, CAR-T, and leukemia service benefits from intake to throughput. The finance specialist understands unique payer contracts, self-pay agreements, patient registration, precertification, authorization process, and maintains accuracy in coding and billing to ensure timely reimbursement. The finance specialist interacts directly with payers to secure insurance authorization for patient transplant, CAR-T, and leukemia medical services to safeguard reimbursement and minimize patient and organization financial risk. The finance specialist works collaboratively with cellular therapy clinical team, patient intake and transplant coordinators, quality, finance, and revenue cycle to help provide financial decision support for clinical operations and to positively impact the revenue cycle. The Cellular Therapy Finance Specialists will participate in meetings relevant to the position, collaborate with the Cellular Therapy Program Quality, Regulatory and Compliance team to establish performance metrics, track cellular therapy financial performance, and report on key performance measures/indicators to the Cellular Therapy Program leadership team and Cellular Therapy Program Quality Assurance and Improvement Committee.

JOB RESPONSIBLITIES

• Verifies patient insurance benefit information for all aspects of the treatment, including, but not limited to, inpatient and outpatient services, prescription drugs, and travel and housing. Assesses need for alternative coverage sources.

• Provides financial counseling to patients and their families specific to their stem cell transplant, CAR-T, leukemia benefits, and self-pay agreements. Serves as the primary resource throughout the patient’s treatment. Discusses benefits and other financial issues with patients and/or family members from initial referral through continuation of care.

• Works in alignment with the cellular therapy intake and transplant coordinators to obtain authorizations and ensure timeliness of patient schedules and care. Routinely influences the approval process through their knowledge of payer policy and subject matter expertise, pursuing the appropriate documentation to support clinical procedures. Accurately and completely documents all information into the patient records system to ensure maximum reimbursement.

• Obtains all necessary signatures and documentation required by the patient’s insurance plan. Performs pre-registration/registration processes.

• Maintains current working knowledge of Medicare, Medicaid, Commercial payor and other program benefits and criteria, particularly as they pertain to long-term care and low-income patients.

• Monitors and updates information regarding insurance data, authorizations, preferred providers, and changes in patient’s treatment plan. Partners with the clinical care team and insurance provider to ensure continued coverage of patient’s care and maximum reimbursement and minimized financial impact to the patient.

• Act as a resource to patient accounting stakeholders. Review and problem solve insurance claim denials. Responsible for escalating approval issues to the cellular therapy finance and clinical leadership team.

• Utilize and maintain current knowledge of patient account management techniques and information systems for registration, coding, billing, medical records, and accounts receivables.

• Maintains accurate statistical, contractual, and financial databases related to stem cell transplant and CAR-T programs. Analyzes statistical data and reports for program specific financial indicators under the direction of the Director of Cellular Therapy Program and senior finance specialist.

• Under the direction of the Director of Quality, Regulatory and Compliance to develop and implement key performance metrics and/or quality indicators that will be used to track and monitor Cellular Therapy Program financial performance and report on key performance measures/indicators to the Cellular Therapy Program leadership team and Cellular Therapy Program Quality Assurance and Improvement Committee.

JOB QUALIFICATIONS

REQUIRED

• Experience: 3-5 years in related field; Experience in stem cell transplant highly preferred

• Education: High school diploma or GED; Associate degree preferred

• Special Skills: Working knowledge of medical and hematology/oncology terminology

PREFERRED

• Special Skills: Working knowledge of stem cell transplant, CAR-T, and malignant hematology terminology

• Training: Annual Stem Cell Transplant & CAR-T

City of Hope is an equal opportunity employer. To learn more about our commitment to diversity, equity, and inclusion, please click here.

To learn more about our comprehensive benefits, click here:Benefits Information