[Hiring] Insurance Specialist @Fresenius Medical Care

Role Description

Developing, experienced team member, supporting the strategic initiatives of the Financial Coordinator Program through knowledge of the eligibility rules for the American Kidney Fund's Health Insurance Premium Program (HIPP), the Indigent Waiver (IW), Employer Group Health Plans (EGHP), Medicare, Medicaid, Medigaps, Commercial Exchange, Commercial Individual, Medicare Advantage, and Veteran's Administration Health Plans. Support FMCNA's mission, vision, core values, and customer service philosophy. Adhere to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements.

Principal Duties and Responsibilities

• Serve as a liaison to the American Kidney Fund's Health Insurance Premium Program (HIPP).
• Responsible for ensuring the efficacy of the AKF HIPP process.
• Review tickets (requests) by term date for accuracy and required supporting documents.
• Communicate and return for completion all inaccurate and incomplete tickets directly with the Insurance Coordinator (ICs) on the ticket.
• Process grants in the AKF Grant Management System (GMS) the same day for urgent grants due to term within 10 days and within 14 days of the term date for non-urgent grants.
• Escalate policies at risk of termination to appropriate management and customer service representatives.
• Request overnight delivery of payments at risk of termination.
• Provide weekly Check Report to ICs of checks issued to their patients by AKF the week prior.
• Run and distribute Return to Requestor reports weekly to ICs, IC Supervisors, and IC Managers.
• Check for Grant Conflicts and resolve discrepancies timely.
• Review processed grants to ensure all premium payments are made timely.
• Check weekly for grants processed that are not updated with a check number and issue date.
• Receive and notify IC accordingly of returned checks from AKF.
• Run initial recurring grant request reports 45 days prior to payment due date and distribute to appropriate IC for review.
• Forward copies of returned AKF checks received from AKF HIPP representatives to the IC assigned to the patient.
• Transfer patients between FMC clinics in GMS upon request and notify all involved parties when transfer is complete.
• Notify AKF HIPP representatives of any patient status changes and request cancellation of recurring grants if warranted.
• Request checks to be voided and reissued if notified payment has not been received and cleared within 45 days.
• Assist the Support Services Manager with reports and projects as needed.
• Review all Indigent Waiver (IW) applications for patients with gaps in coverage to determine patient eligibility.
• Receive completed IWs from the Insurance Coordinator (IC) via email and record receipt in the system.
• Ensure that IWs are reviewed within 30 days of receipt.
• Forward approved IWs to RVP or DO to obtain approval signature.
• Document status of approved IW in the system through completion.
• Maintain a source file of all IWs received and the status of each.
• Scan approved IWs into Document Imaging (DI).
• Compile monthly reports, including all IWs approved both monthly and year-to-date.
• Answer all email and voicemail communications within 24 hours of receipt.
• Assist with reports and projects as needed.
• Escalate issues to supervisor for resolution, as deemed necessary.
• Review and comply with the Code of Business Conduct and all applicable company policies and procedures.
• Assist with various projects as assigned by direct supervisor.
• Other duties as assigned.

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.
• Minimal travel required.

Education

• High School Diploma required.

Experience and Required Skills

• 1-2 years related experience.
• Knowledge of various insurance types.
• Knowledge of dialysis industry a plus.
• Excellent written and verbal skills.
• Detail oriented.
• Strong organizational and time management skills.
• Proficient with PCs and Microsoft Office applications.

Company Description

Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws. Fresenius Medical Care is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sexual orientation, gender identity, parental status, national origin, age, disability, military service, or other non-merit-based factors.