Insurance Program Manager

3 weeks ago


Gurnee, Illinois, United States FRESENIUS MEDICAL CENTER Full time
Job Summary

We are seeking an experienced Insurance Coordinator to join our team at Fresenius Medical Care North America. The successful candidate will be responsible for overseeing the day-to-day activities of the Insurance Coordinators, providing direction, support, and guidance as needed. This role requires strong communication and organizational skills, as well as the ability to work effectively in a fast-paced environment.

Key Responsibilities
  • Facilitate the execution of the Insurance Coordinator program, ensuring insurance preservation of dialysis patients by supervising the activities of the Insurance Coordinators.
  • Contribute to and ensure problem resolution by addressing and investigating escalated issues and complex problems.
  • Provide guidance, direction, training, and support to Insurance Coordinators to ensure they are meeting the needs of the patients they serve.
  • Review and audit Insurance Coordinator's database reports to ensure compliance and productivity.
  • Coordinate and provide monthly Insurance Coordinator database reports for the region, communicating the results and escalating concerns to the IC Manager as necessary.
  • Ensure accuracy of reports by comparing reports with the effective insurance reports.
  • Work with IC's regarding any missing information or discrepancies between reports.
  • Provide counseling and additional training to IC's as necessary.
  • Ensure accurate tracking and monitoring of Coordination of Benefit period and ensure that the Medicare applications are processed 90 days prior to the 30-month coordination period ending as required.
  • Monitor patients within the 6-month window of their 65th birthday, resulting in possible additional insurance enrollment and optimal insurance coverage for patients.
  • Provide IC Manager and Division management with documentation and follow-up for all patients categorized on status reports.
  • Monitor the accuracy and completion of progress notes, providing guidance to IC's as necessary.
  • Compile monthly reports from insurance Coordinator team for compilation in Division monthly reports.
  • Provide IC Director with monthly reports in the absence of the IC Manager.
  • Communicate to IC team Company updates as well as any new regulatory/legislative updates.
  • Provide day-to-day guidance, training, and assistance to assigned Insurance Coordinators as part of continued career development and advancement within the organization.
  • Closely monitor - providing support and guidance to - new Insurance Coordinators after initial training.
  • Address identified performance issues with Insurance Coordinators and provide a plan of action and additional training to ensure the Insurance Coordinators are meeting the expectations of the position.
  • Implement developmental Action Plans as appropriate.
  • Provide informal feedback on an ongoing basis and formal feedback in the form of the annual performance evaluation.
  • Provide input regarding the hiring, firing, and disciplinary actions pertaining to the assigned Insurance Coordinators.
  • Assist with preparation of monthly reports for financial analysts.
  • Participate in Regional AR calls, area management meetings, and RVP meetings as appropriate.
  • Provide information at CQI monthly meetings when requested.
  • Participate in Clinic Acquisition calls to ensure smooth transition of existing patients' insurance needs while onboarding into FKC's billing system.
  • Analyze reports from billing systems to ensure accuracy of data.
  • Research and assist with resolution of identified discrepancies and accounts with outstanding claims to maximize revenue and minimize bad debt.
  • Analyze trends and variances and research significance.
  • Report discrepancies for quick and accurate resolution.
  • Work with the Insurance Specialist (IS) team to reconcile IC and Regional Insurance Coordinators' American Kidney Foundation spreadsheets/reports to ensure timely submission of requests and payments.
  • Investigate and resolve discrepancies to ensure timely processing of Health Insurance Premium Program (HIPP) grant requests.
  • Provide the necessary follow-up with the appropriate agencies and personnel as required.
  • Develop strong working relationships with Directors of Operations, Regional Vice Presidents, MSW Leads, and Billing Management.
  • May intervene on behalf of the Insurance Coordinators to escalate issues to Operations or other FKC Management teams.
  • Provide education to Operations and clinical staff and area/regional management as to the IC role and responsibilities as needed.
  • Identify areas of opportunity and contribute to process improvement with the Insurance Coordinator Manager to enhance the overall program effectiveness and efficiency.
  • Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state, and federal laws and regulations.
  • Ensure all employees within the assigned team(s) understand and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state, and federal laws and regulations; establishing and maintaining effective internal systems and controls to promote compliance.
  • Assist with various projects as assigned.
Requirements
  • Bachelor's degree required.
  • At least 2-3 years' experience in the Insurance Industry.
  • Specific knowledge of and experience with Employer Group Health Plans (EGHP), COBRA, Medicare, Medicaid, Medigaps, Individual/State Risk Pools, and Veteran's Administration (VA) Health Plans required.
  • Prior Supervision and Project Management experience a plus.
  • Excellent communication skills - written and verbal with the ability to communicate to all levels of management.
  • Detail-oriented.
  • Excellent customer service, organizational, time management, and interpersonal skills required.
  • Proficient with PCs and Microsoft Office applications.
EO/AA Employer

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



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