Under general supervision of the Transplant Financial Services Manager, this position serves as a liaison between hospital, patient and third-party payors for all financial matters is secures all necessary authorizations to ensure transplant related services are approved by any third-party payors before proceeding with treatment. This position also ensures the patient/family has a thorough understanding of the transplant benefits available to them and any coverage restrictions before a transplant is undertaken.

1. Payer Financial Coordination
   • Performs a variety of financial coordination critical to the support of the transplant programs, including assessment of patient financial status, determination of insurance coverage and/or entitlement benefits specific to transplant, facilitation of referral, financial, and service authorization approval process, documentation and communication of financial and health benefits information. Advocates for patient with third party payers to gain maximum provider choice and insurance benefits.
2. Transplant Episode of Care
   • Tracks all transplant patient cases across the transplant episode of care, identifying and coordinating with sub-contracted providers and vendors, and categorizing transplant services within the appropriate transplant clinical phase for billing and collection purposes. Identifies services that are included in the transplant episode of care or any applicable global billing period as well as discrepancies, time gaps and other anomalies that could adversely impact PCH`s ability to bill and obtain reimbursement for services rendered and ensure proper documentation and/or issue resolution. Ensures all requirements are met within established time frames.
3. Patient/Family Financial Coordination
   • Participates with the initial patient orientation process and provides ongoing patient education in regarding the patient/families’ insurance coverage. Obtains and explains patient insurance benefit information and insurance coverage to patient/family and hospital. Obtains demographic and financial information and evaluates financial status of patients. Estimates insurance coverage and potential non-covered services. Assists family with all applicable financial support coverage and/or programs. Introduces patient/family to COTA to assist with fundraising, if the family participates.
4. Transplant Financial Database and Documentation
   • Secures and reviews patient financial, clinical and demographic information from a variety of sources including, but not limited to, hospital and medical group registration and billing systems, medical records and clinical data systems to determine patient financial and clinical eligibility under transplant and acute care benefit programs.
   • Updates transplant financial database to ensure accuracy of patient demographic, third party payer authorizations, clinical and financial data for information tracking and report generation.
5. Committees and Meetings
   • Attends and participates in transplant team meetings including patient selection committee, hospital multidisciplinary meetings, and QAPI with the ability to communicate with the transplant clinical teams in a professional and effective manner. Includes appropriate preparation for meetings, and all required follow-up to ensure that all financial issues are addressed timely.
6. Call Coverage
   • Rotates in for on-call and after-hours support of the transplant clinical teams for urgent and emergent situations.
7. Other Duties
   • All other duties as assigned to support Transplant Financial Services and Patient Access.
8. Performs miscellaneous job related duties as requested.

To advance hope, healing and the best healthcare for children and their families

Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.

We realize this vision by:

• Offering the most comprehensive care across ages, communities and specialties
• Investing in innovative research, including emerging treatments, tools and technologies
• Advancing education and training to shape the next generation of clinical leaders
• Advocating for the health and well-being of children and families

• We place children and families at the center of all we do
• We deliver exceptional care, every day and in every way
• We collaborate with colleagues, partners and communities to amplify our impact
• We set the standards of pediatric healthcare today, and innovate for the future
• We are accountable for making the highest quality care accessible and affordable