Manager, Insurance Specialists (Ellenwood)
Compensation: $64,410.00 - $95,140.00 /year *
Employment Type: Full-Time
Industry: Financial Services - Insurance
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PURPOSE AND SCOPE:
Provide leadership, direction and oversight of the American Kidney Funds Health Insurance Premium Program (HIPP) and Indigent Waiver (IW) in support of the strategic initiatives of the Insurance Coordination Program through an in-depth knowledge of eligibility rules for the American Kidney Funds Health Insurance Premium Program (HIPP), the Indigent Waiver (IW), Employer Group Health Plans (EGHP), Medicare, Medicaid, Medigaps, Commercial Exchange, Commercial Individual, Medicare Advantage, and Veterans Administration Health Plans. Ensure the Insurance Specialist team are performing all required processes, procedures, and functions according to the established timelines and standard operation procedures in compliance with company and regulatory guidelines and requirements. Support FMCNAs mission, vision, core values and customer service philosophy. Adhere to the FMCNA Compliance Program, including following all regulatory and division/company policy requirements.
PRINCIPAL DUTIES AND RESPONSIBILITIES: Manage the tactical execution of short- and long-term objectives through the coordination of activities with a direct responsibility for results, including costs, methods, staffing, and day-to-day operations of assigned teams, projects and initiatives. Direct AKF HIPP and IW Approver Insurance Specialists and Supervisor in following company policy and procedures within their designated roles. Update and maintain the AKF clinic database including new clinics, Insurance Coordinator (IC), Insurance Coordination Supervisor, and AFK HIPP Insurance Specialist liaison assignments. Monitor for accuracy with ticket assignments and process data and alert AKF liaisons of discrepancies. Escalate matters of importance to AKF management such as urgent requests, GMS processing and system issues, clinic updates, new clinic additions and GMS user accounts. Routinely review distribution of the number of patients per Insurance Specialist to ensure a fairly equitable workload and initiate clinic reassignments accordingly. Redirect staff and provide support to ensure adequate coverage during times of high-volume processing. Responsible for timely communications to Insurance Specialists and Insurance Coordination teams regarding AKF, GMS, IWs, and systems with respect to program changes and updates. Ensure program policy and procedures are reviewed and updated regularly in accordance with company and AKF policy. Interact with internal department; particularly in problem resolution. Act as an advisor to subordinate(s) to meet schedules and/or resolve technical problems. Oversee training of new staff directly and indirectly to ensure competency in their designated responsibilities. Partnering with Human Resources and department leader, responsible for hiring, coaching and counseling employees, including performance reviews, disciplinary action and terminations. Provide leadership, coaching and development plans for all direct reports to maintain an engaged and productive workforce; partnering with Human Resources and department leader on employee matters. Establish progressive relationships with team to maintain an engaged and productive workforce. Provide GMS and AFK SharePoint system training to the Insurance Coordinators on an as-needed basis. Provide AKF related reports as requested. Apply expertise to achieve consistent and efficient solutions of high quality and to apply effective strategies. Assist with and resolve escalated issues. Erroneous decisions or failure to achieve results will add costs and may impact the short-term goals of the organization. Maintain technical proficiency and knowledge of industry practice and business principles. Provide subject matter expertise (SME), liaising standards, government regulations, procedures and issue management ensuring resolution and result. Actively manage available resources to provide timely, valued, quality services. Follow processes and operational policies in selecting methods and techniques for obtaining solutions. Interpret and recommend change to policies and establish procedures that effect immediate organization(s). Interact and partner with subordinate supervisors, and/or functional peer group managers, normally involving matters between functional areas, other company divisions or units, or customers. Participate and present at meetings with internal and external representatives. Often leading a cooperative effort among members of a project team.Support executive management in operations and in upholding FMCNAs mission, vision, core values, and customer service.Escalate issues to direct supervisor for resolution, as deemed necessary. Appropriately escalate matters of urgency.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. 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.
Qualifications 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. Travel required. SUPERVISION: May be responsible for the direct supervision of various levels of department staff. EDUCATION: Bachelors Degree required Advanced Degree desirable EXPERIENCE AND REQUIRED SKILLS: 6 8 years directly related experience required. 3+ years supervisory or project/program management experience preferred. Comprehensive knowledge of various insurance types, regulations, policies and processes required. Comprehensive understanding of the business, corporate culture and ability to keep up with evolving priorities. Demonstrated leadership ability of encouraging high standards of behavior and ability to delegate responsibility, adapt leadership style to situations and people, and empower, motivate, and guide others. A team player is desired for this role. Strong organizational and time management skills with high orientation for detail; ability to effectively prioritize and execute tasks. Exemplary communication, customer service and interpersonal skills with the ability to develop and cultivate successful relationships with high profile stakeholders, vendors, and assigned staff, communicate with all levels of management, lead internal work streams and work as part of a team. Excellent verbal, written, and presentation skills. Demonstrated ability to analyze, synthesize, evaluate, formulate, and make sound decisions; translate strategy into action; communicate complex issues; orchestrate plans to resolve issues and mitigate risks. Highly self-motivated, focused and energetic with the ability to work efficiently in a fast-paced environment while remaining flexible, proactive, resourceful, calm and efficient. Knowledge of dialysis industry a plus. Proficient with PCs and Microsoft Office applications.
EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity
Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.
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