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.
• Indigent Waiver (IW) Approvals. Review all Indigent Waiver (IW) applications for patients with gaps in coverage to determine patient eligibility.  The Indigent Waiver program purpose is to assist patient who are unable to obtain full insurance coverage and who do not have the financial resources to pau for their portion of medical services provided by FMCNA.  Any patients who are believed to be eligible for insurance coverage or assistance of any type should be encouraged and expected to pursue such.
• Receive completed IWs from the Insurance Coordinator (IC) via email and record receipt in system.
• Review IW for completeness and accuracy according to IW procedure guidelines.
• 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 system through completion.
• Maintain a source file of all IWs received and the status of each (approved, denied, pending additional documentation) and update on a daily basis.
• Scan approved IWs into Document Imaging (DI). 
• Compile monthly reports, including all IWs approved both monthly and year-to- date, by the 5th of the following month and forward to the Support Service Manager, Insurance Coordination Manager and Self-Pay team.
• Answer all email and voicemail communications within 24 hours of receipt.  If urgent, must respond same day.
• 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, local, state and federal laws and regulations.
• Assist with various projects as assigned by direct supervisor.
• 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.

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