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PURPOSE AND SCOPE:
Supports FMCNA’s mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and RRI policy requirements.
Explores, recommends, and coordinates the varied financial assistance options available to RRI kidney dialysis patients in order to ensure the provision of the best financial resources possible for each patient in the assigned clinics, while maximizing revenue for the company.
DUTIES / ACTIVITIES:
- Responsible for driving the FMS culture though values and customer service standards.
- Accountable for outstanding customer service to all external and internal customers.
- Develops and maintains effective relationships through effective and timely communication.
- Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.
PRINCIPAL RESPONSIBILITIES AND DUTIES
- Meets regularly with dialysis patients at the clinics to:
- Educate as to availability of alternative insurance options (i.e., Medicare, Medicaid, Medicare Supplement, State Renal programs and COBRA).
- Make sure the patients have followed through with the application process.
- Obtain premium statements and signatures from patients.
- Discuss situation and options if employment status changes or other situations change.
- Complete and follow up with paperwork when claims not released for payments.
- Collect necessary documents to completed initial and annual indigent waivers.
- Discuss 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-instatements.
- 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 period ends.
- Monitoring and verifying the Medicaid status of each patient on a monthly basis.
- Determining the spend-down amounts.
- Collects financial information to determine if premium assistance is needed. This may include but is not limited to the following:
- Completing the American Kidney Fund (AKF) premiums assistance applications on behalf of the patients who qualify.
- Preparing quarterly premium payment requests on all participating patients.
- Visits assigned clinics on a daily basis to meet with patients to identify, address, research and resolve insurance coverage issues.
- Works with patients to assimilate personal financial information to determine if patient qualifies for indigent program.
- Completes the initial Indigent waiver applications.
- Tracks and completes the 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 monthly Financial Coordinator reports to track work progress on monthly basis and to submit to pertinent personnel. Reports include:
- Number of patients without secondary coverage
- Patients who have obtained a secondary waiver
- American Kidney Foundation patients, 30-month coordination patients and COBRA patients plus total number patients
- Insurance changes
- Non compliant patients
- If a patient does not qualify for coverage - the explanation as to why and what actions were taken
- Annual and initial waiver applications, co-pays etc.
- 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 policies.
- 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. Extensive local travel.
Bachelors’ degree required - Social Work or other Healthcare focus preferred. Or RN associates with two years of nursing experience in lieu of degree.
EXPERIENCE AND REQUIRED SKILLS
- At least 1 year of Healthcare experience with specific knowledge of and experience with Medicare, Social Security and Medicaid systems.
- Excellent written and verbal skills.
- Detail oriented.
- Strong organizational and time management skills.
- Proficient in Excel and Microsoft Word.
EO/AA Employer: Minorities/Females/Veterans/Disabled
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