Insurance Coordinator

PURPOSE AND SCOPE

Explores, recommends, and coordinates insurance and potential financial assistance options available to kidney dialysis patients in a specified geographic area, while providing our patients education to elect the best insurance options for them. Supports FMCNA’s mission, vision, core values and customer service philosophy.

PRINCIPAL DUTIES AND RESPONSIBILITIES

• Mets regularly with dialysis patients at the clinic(s) in the assigned region to educate and coordinate insurance options:
• Educates on the availability of alternative insurance options (i.e., Medicare, Medicaid, Medicare Supplement, State Renal programs, and COBRA).
• Ensures patients have followed through with the application process.
• Obtains premium statements and signatures from patients.
• Discusses situation and options if employment status changes or other situations change.
• Completes and follows up with paperwork when claims are disputed for non-payment.
• Collections necessary documents to complete indigent waivers.
• Discusses insurance options when insurance contracts are terminated.
• Responsibilities involving Medicare and Medicaid include but are not limited to:
• Determining Medicare eligibility by meeting with the patients and contacting local Social Security offices to verify eligibility.
• Discussing the Medicare application with eligible patients and assisting with the application process.
• Acting as liaison between the patient and the local agents for Medicare terminations and re-in statements.
• Educate and review insurance options for annual open enrollment and Medicare reinstatement periods with patients.
• Tracking 30-month coordination period each month for those patients on employer Group Health Plans to ensure Medicare will be in place once coordination ends.
• Monitoring and verifying the Medicaid status of each patient monthly and determining the spend down amounts.
• Works with patients to evaluate personal financial information and make determination for indigent program.
• Completes initial Indigent waiver applications.
• Maintains all patients’ insurance information to ensure it is updated and accurate for the Revenue Cycle Management.
• Addresses any identified anomalies or discrepancies, research and answers questions as needed.
• Reviews and complies with the Code of Business Conduct and all applicable company policies and procedures, local, state, and federal laws, and regulations.
• Provides QA team members with monthly information regarding the details of the patients’ primary and secondary insurance status as well as documentation regarding the plans of actions currently in place monthly as required by QA processes.
• Completes monthly audit exam to stay current on internal policies.
• May present insurance and financial assistance options to patients as necessary.

PHYSICAL DEMANDS AND WORKING CONDITIONS

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

Extensive local travel to clinics in a specified geographic area; must have a valid Driver’s License.

SUPERVISION

None

EDUCATION

Bachelor’s Degree preferred, Social Work or other Healthcare focus preferred. High school diploma would require minimum of 5+ years of experience in similar position or insurance experience.

EXPERIENCE AND REQUIRED SKILLS

• 2 – 5 years’ related experience; healthcare industry preferred.
• Experience with Medicare, Social Security and Medicaid systems a plus.
• Past patient interaction a plus.
• Excellent written and communication skills.
• A 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