Insurance Coordinator

About the Role

Explores, recommends, and coordinates the insurance and potential financial assistance options available to kidney dialysis patients in a specified geographic area, while maximizing revenue for the company. Supports the mission, vision, core values, and customer service philosophy of Fresenius Medical Care North America (FMCNA). Adheres to the FMCNA Compliance Program, including following all regulatory and company policy requirements.

Responsibilities

• Meets regularly with dialysis patients at assigned clinic(s) to educate and coordinate insurance options:
  • Educates on alternative insurance options (e.g., Medicare, Medicaid, Medicare Supplement, State Renal programs, and COBRA).
  • Ensures patients follow through with the application process.
  • Obtains premium statements and signatures from patients.
  • Discusses options if employment status or other situations change.
  • Completes and follows up on paperwork for disputed claims due to non-payment.
  • Collects necessary documents for initial and annual indigent waivers.
  • Discusses insurance options when contracts are terminated.
• Handles Medicare and Medicaid responsibilities, including but not limited to:
  • Determining Medicare eligibility by meeting with patients and contacting local Social Security offices.
  • Assisting eligible patients with the Medicare application process.
  • Acting as a liaison between patients and local agents for Medicare terminations and reinstatements.
  • Completing annual open enrollment and Medicare reinstatement paperwork with patients.
  • Tracking the 30-month coordination period for patients on employer Group Health Plans to ensure Medicare is in place once coordination ends.
  • Monitoring and verifying Medicaid status monthly, including determining spend-down amounts.
• Evaluates patients' personal financial information to determine eligibility for indigent programs, including:
  • Completing initial and annual indigent waiver applications.
• Monitors all patients' insurance information to ensure accuracy and updates for the Accounts Receivable Department, addressing anomalies or discrepancies as needed.
• Meets with patients receiving direct payments from insurance companies to ensure payment of dialysis treatments owed to Fresenius.
• Prepares, analyzes, and reviews monthly reports to track work progress on caseloads and ensure correct insurance information is entered into billing systems.
• Researches and corrects discrepancies identified in patient reports.
• Provides QA team members with monthly updates on patients' primary and secondary insurance status and documentation of action plans.
• Completes monthly audit exams to stay current on internal policies.
• May present on insurance and financial assistance options to patients as necessary.
• Assists with various projects as assigned by a direct supervisor.
• Performs other duties as assigned.

Requirements

• Bachelor’s Degree required; Social Work or other Healthcare focus preferred.
• 2–5 years of related experience; healthcare industry experience preferred.
• Experience with Medicare, Social Security, and Medicaid systems is a plus.
• Past patient interaction experience is a plus.
• Excellent written and communication skills.
• Strong customer service philosophy.
• Strong organizational and time management skills.
• Ability to work independently.
• Proficient with PCs and Microsoft Office applications.
• Valid Driver’s License.
• Extensive local travel to clinics in a specified geographic area.

Physical Demands and Working Conditions

Day-to-day work includes desk and personal computer work, as well as interaction with patients and facility staff. The work environment is characteristic of a healthcare facility with controlled air temperature and moderate noise levels. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.