Financial Services Advisor - Greater Houston Area at U.S. Renal Care in Plano, Texas

Job Description:

Supports insurance retention through direct patient education and enrollment to ensure patients have optimal health insurance coverage. Explores, recommends, and coordinates insurance enrollment. Promote retention of insurance plans and alternatives to coverage gaps resulting in maximized revenue for USRC. Advocate for the patient regarding their insurance coverage. Adheres to the USRC Compliance Program. This position may be responsible for various states.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Contact all new commercial permanent patients within 5 business days of admission. Review insurance benefit information received upon admission. Determine what benefits the patient may be eligible for to help cover the cost of dialysis.
• Meet with patients that are at risk for terminating the commercial coverage.
• Read and interpret COBRA policies to help patients navigate through the process to covert to a COBRA policy and educate the patient on how COBRA will affect their dialysis benefits. Assist with enrollment application as needed.
• Track patients that are on COBRA. When appropriate, help patients apply for extensions.
• Establish good working relations with clinic staff and area hospitals
• Train discharge planners in the surrounding hospitals regarding insurance coverage related to dialysis.
• Conduct educational meetings and present materials to assigned hospitals and nephrologist practice managers
• Track coordination of benefit dates and other vital information in department tracking tool to avoid a negative financial impact to the company.
• Educate patients and clinics on available assistance programs
• Responsible for verifying if all patient commercial primary premiums are being paid through premium assistance programs. Must be able to make the determination if patients meet the eligibility requirements for the insurance premium assistance program.
• Responsible for collecting checks paid to patients to recoup monies owed to the company.
• Work with the patient and insurance carrier to reinstate coverage
• Initiate insurance member appeals on behalf of the patient

• Engage in Pre-CKD processes to provide education and increase patient admissions
• Create monthly status reports for the Director of Operations, Clinical Manager, Social Worker, Insurance Operations Director and VP of Revenue Cycle Managemen
• Educate patients of the benefits available under the Affordable Care Act during open enrollment or qualifying event
• Participate in QAPI or other facility meetings and present potential risk related to loss of insurance coverage
• Develop and maintain patient portfolios for retention review
• Prepare and deliver weekly reporting on key metrics and benchmarks established by management
• Other duties as assigned