Insurance Coordinator

PURPOSE AND SCOPE:

Oversees the day to day activities of the Insurance Coordinators (IC's) providing direction, support and guidance as appropriate. Assists the Insurance Coordinator Manager with the execution of the strategies and initiatives of the IC program within the assigned regions/Divisions. Ensures the IC's are performing the required processes, procedures, and functions with regard to tracking, reporting, enrolling, and educating patients on their insurance options.  Oversees the varied insurance financial assistance options according to the established timelines and standard operation procedures in compliance with company and regulatory guidelines and requirements. Supports FMCNA's mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and division/company policy requirements.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Facilitates the execution of the Insurance Coordinator program providing for insurance preservation of dialysis patients by supervising the activities of the Insurance Coordinators (IC) ensuring each individual's work meets the established performance standards and customer service levels with regard to patient insurance education and enrollment.  Contributes to and ensures problem resolution by addressing and investigating escalated issues and complex problems.
• Provides guidance, direction, training, and support to Insurance Coordinators to ensure they are meeting the needs of the patients they serve and that they demonstrate insurance awareness of the issues in the Areas in which they work including eligibility and enrollment acting as a resource and subject matter expert as needed to ensure the proper and timely execution of the Insurance Coordinator program requirements.

• Reviews and audits Insurance Coordinator's data base reports to ensure compliance and productivity.  Reviews monthly reports submitted by IC's to ensure the patients are receiving the education, proper insurance enrollment, and assistance needed to secure optimal insurance coverage, AKF assistance, and/or Indigent waiver approval as necessary.

  • Coordinates and provides monthly Insurance Coordinator data base reports for the region communicating the results and escalates concerns to the IC Manager for review as necessary
  •  Ensures accuracy of reports by comparing reports with the effective insurance reports.  Works with IC's regarding any missing information or discrepancies between reports.
  • Provides counseling and additional training to IC as necessary
  • Ensures accurate tracking and monitoring of Coordination of Benefit period and ensures that the Medicare applications are processed 90 days prior to the 30-month coordination period ending as required.
  • Monitors patients within the 6-month window of their 65th birthday, resulting in possible additional insurance enrollment and optimal insurance coverage for patients
  • Provides IC Manager and Division management with documentation and follow-up for all patients categorized on status reports
  • Monitors the accuracy and completion of progress notes providing guidance to IC as necessary.
  • Compiles monthly reports from insurance Coordinator team for compilation in Division monthly reports
• Provides IC Director with monthly reports in the absence of the IC Manager.
• Communicates to IC team Company updates as well as any new regulatory/legislative updates.

• Provides day to day guidance, training and assistance to assigned Insurance Coordinators as part of continued career development and advancement within the organization. 

  • Closely monitors - providing support and guidance to - new Insurance Coordinators after initial training.
  • Addresses identified performance issues with Insurance Coordinators and provide a plan of action and additional training to ensure the Insurance Coordinators are meeting the expectations of the position. If consistent performance issues are identified, implements developmental Action Plans as appropriate.
  • Provides informal feedback on an ongoing basis and formal feedback in the form of the annual performance evaluation.
  • Provides input regarding the hiring, firing and disciplinary actions pertaining to the assigned Insurance Coordinators.
• Assists with preparation of monthly reports for financial analysts.
• Participates in Regional AR calls, area management meetings, and RVP meetings as appropriate.  Provides information at CQI monthly meetings when requested.
• Participates in Clinic Acquisition calls to ensure smooth transition of existing patients' insurance needs while onboarding into FKC's billing system.
• Analyzes reports from billing systems to ensure accuracy of data.  Researches and assists with resolution of identified discrepancies and accounts with outstanding claims to maximize revenue and minimize bad debt.  Analyzes trends and variances and researches significance. Reports discrepancies for quick and accurate resolution.
• Works with the Insurance Specialist (IS) team to reconcile IC and Regional Insurance Coordinators' American Kidney Foundation spreadsheets/reports to ensure timely submission of requests and payments. Investigates and resolves discrepancies to ensure timely processing of Health Insurance Premium Program (HIPP) grant requests.  Provides the necessary follow up with the appropriate agencies and personnel as required.
• Develops strong working relationships with Directors of Operations, Regional Vice Presidents, MSW Leads and Billing Management.  May intervene on the behalf of the Insurance Coordinators to escalate issues to Operations or other FKC Management teams.  Provides education to Operations and clinical staff and area/regional management as to the IC role and responsibilities as needed.
• Identifies areas of opportunity and contributes to process improvement with the Insurance Coordinator Manager to enhance the overall program effectiveness and efficiency.
• Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations.
• Ensure all employees within the assigned team(s) understand and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations; establishing and maintaining effective internal systems and controls to promote compliance.
• Assist with various projects as assigned.
• Other duties as assigned.

Additional responsibilities may include focus on one or more departments or locations.  See applicable addendum for department or location specific functions.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

• The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Extensive local travel and some regional travel is required.
• Must have a valid Driver's License

SUPERVISION:

• Typically 8 Insurance Coordinators in an assigned region

EDUCATION:

• Bachelor's degree required.

EXPERIENCE AND REQUIRED SKILLS:

• At least 2-3 years' experience in the Insurance Industry.
• Specific knowledge of and experience with Employer Group Health Plans (EGHP), COBRA, Medicare, Medicaid, Medigaps, Individual/State Risk Pools, and Veteran's Administration (VA) Health Plans required.
• Prior Supervision and Project Management experience a plus.
• Excellent communication skills- written and verbal with the ability to communicate to all levels of management.
• Detail oriented.
• Excellent customer service, organizational, time management and interpersonal skills required.
• Proficient with PCs and Microsoft Office applications.

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.