PURPOSE AND SCOPE:
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 FMCNA's mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and company policy requirements
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Meets 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.
- Collects necessary documents to completed initial and annual 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.
-
Completing the annual open enrollment and Medicare reinstatement papers with the patients.
-
Tracking 30-month coordinator 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 on a monthly basis 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.
-
Tracks and completes annual indigent waiver applications.
-
Monitors all patients' insurance information to ensure that it is updated and accurate for the Accounts Receivable Department.
-
Addresses any identified anomalies or discrepancies, researches and answers questions 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; Analyzes patient reports from billing systems as an audit check to ensure the correct insurance information is entered into the billing system and that other changes are not overlooked. Researches and corrects any discrepancies identified.
-
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 on a monthly basis as required by QA processes
- Completes monthly audit exam to stay current on internal policies.
-
May present on insurance and financial assistance options to patients as necessary.
-
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.
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. 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.
EDUCATION:
- Bachelor's Degree required; Social Work or other Healthcare focus preferred.
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
Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws.
