Insurance Benefit Coordinator

Planned Parenthood CWNY•City of Rochester, NY

11d•$20 - $24•Hybrid

About The Position

The Insurance Benefits Coordinator (IBC) is responsible for coordinating and supporting initiatives related to the evaluation, processing, and handling of Presumptive Medicaid (PEP/MAPE), Presumptive Eligibility Family Planning Benefit Program (PEFPBP), and Family Planning Benefit Program (FPBP) applications from all sites. The IBC works collaboratively with all Health Center teams to identify potentially eligible uninsured or underinsured patients and pregnant women to determine eligibility for specific state-sponsored FPBP and Presumptive health insurance programs. The IBC also works individually with identified patients to ensure timely submission of applications and required documentation. The IBC tracks enrollment progress, compiles data, establishes and monitors team goals, provides support for daily questions and training, and educates front desk staff across Shared Services. This position has responsibility across three NYS affiliates through Shared Services: Planned Parenthood of Central and Western New York, Upper Hudson Planned Parenthood, and Planned Parenthood of the North Country.

Requirements

Associate’s degree in business, health care, or a related field; Bachelors preferred.
Minimum one year of experience in a healthcare setting; insurance coverage verification and/or billing preferred.
Certified Application Counselor (CAC) designation; certification must be obtained within six months of job acceptance.
Knowledge of insurance guidelines and government programs (i.e., Medicaid).
Proficient in Microsoft Office (i.e., Excel, PowerPoint and Word).
Strong analytical and problem-solving skills.
Demonstrates sensitivity toward patient’s financial and clinical needs, while maintaining patient’s confidentiality.
Organized, able to prioritize tasks, and handle multiple projects.
Accuracy and attention to detail is essential.
Able to work independently and as a team player.
Able to multi-task and work in a fast-paced environment.
Exceptional communication skills (verbal and written) and interpersonal skills.
Able to work a flexible schedule to support meetings and activities and travel to other sites.
Must have reliable transportation.
Proficient in two or more languages is preferred.

Nice To Haves

Bachelors degree
Insurance coverage verification and/or billing experience
Proficiency in two or more languages

Responsibilities

Completes the full cycle of identification, enrollment, submission, and follow-up for patients eligible for government benefit programs.
Ensures accuracy and completeness of applications taken by other staff and assists patients/staff with submission requirements.
Represents the client in the application process and serves as liaison between the affiliate and the governmental entity.
Processes applicants’ recertification, terminations, and other inquiries from Local Department of Social Services (LDSS).
Compiles monthly statistics on application status.
Attains goals for new enrollees and reinstatements.
Trains and evaluates health center staff on enrollment processes.
Implements new or existing programs to help patients obtain insurance coverage.
Verifies patient insurance coverage and reviews high-ticket items for prior approvals.
Inputs accurate data into insurance systems and verifies existing information.
Explains coverage amounts and discusses financial obligations and payment options with patients.
Assists in obtaining necessary Medicaid or health program eligibility documents.
Handles application status inquiries from sites.
Serves as support for day-to-day questions and training, and provides education to front desk staff.
Works flexibly and cooperatively with health center staff.
Monitors status of all outstanding applications and follows up on pending or incomplete applications.
Responsible for timeliness, accuracy, and completeness of documentation on patient accounts and follows up with DSS and patients regarding enrollment status.
Processes all FPBP communications.
Enters insurance information in NextGen for Acceptance/Denials and notifies the Billing Department.
Contacts patients for Renewals, documents in NextGen, and checks for past DOS for billing.
Completes notes in NextGen system and deactivates insurance for Discontinuation.
Builds and maintains positive relationships with internal and external customers.
Demonstrates commitment to exceeding customer expectations.
Responds positively to customers.
Participates in Department of Health (DOH) training and other educational opportunities.
Participates in affiliate initiatives.
Participates in and adheres to the agency’s Compliance, Quality and Risk Management (CQRM) program.
Performs other duties as assigned.
Performs all functions in a manner that upholds the agency’s mission, vision, and values.