Insurance Specialist

PURPOSE AND SCOPE

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

Under general supervision, follow established company policies and procedures and apply acquired job skills in performing duties. Primary duties are semi-routine in nature requiring full knowledge of general aspects of the job, with occasional deviation from accepted practice.

• Serve as a liaison to the American Kidney Fund's Health Insurance Premium Program (HIPP). The purpose of the AKF HIPP is to provide health insurance grants to eligible ESRD patients on dialysis for the purpose of paying their Medicare Part B, Medicare Advantage, Medigap, Commercial Exchange, Commercial Individual, or COBRA medical premiums. HIPP Is supported 100% by provider contributions. 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 their patients by AKF the week prior.
• Run and distribute Return to Requestor reports weekly to ICs, IC Supervisors and IC Managers to remind ICs of requests that have been returned for grants that could not be processed or sent back as incomplete.
• After weekly Check Status Report is uploaded and available, check for Grant Conflicts and resolve and issue to ensure discrepancies are addressed timely. Review processed grants to ensure all premium payments are made timely so that policies do not term.
• Check weekly for grants processed that are not updated with a check number and issue date. Communicate any issues due to non-payment of processed grant to both AKF and ICs.
• Receive and notify IC accordingly of returned checks from AKF, record on patient tab in applicable system, and overnight checks weekly to AKF. A new request is entered by the IS and processed in GMS if needed to cover premium(s) for payment returned.
• 45-days prior to payment due date, run initial recurring grant request reports and distribute to appropriate IC for review. Once IC responds, release grants for payment as directed by the IC. Check weekly for recurring grants due to be released until month end to ensure grants that come up in queue are not missed and released for payment.
• Forward copies of returned AKF checks received from AKF HIPP representatives to the IC assigned to the patient. Record on the patient tab in applicable system.
• 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. Create a new one-time request ticket for any check reissue request.
• Assist the Support Services Manager with reports and projects as needed.

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.

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