Insurance Benefit Coordinator

Planned Parenthood of Central and Western New York (PPCWNY) protects and provides health care and education that empowers individuals and families. With respect. Without judgment. No matter what.

In support of PPCWNY’s mission, the Insurance Benefits Coordinator (IBC) has responsibility for coordinating and supporting initiatives relative 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 as assigned to identify potentially eligible uninsured or underinsured patients and pregnant women in order to determine eligibility for specific state sponsored FPBP and Presumptive health insurance programs, as well as works individually with identified patients, as needed, to ensure timely submission of applications and required documentation. The IBC tracks the progress of all enrollments, compiles data to reflect current progress, establishes and monitors goals for the team, serves as support for day-to-day questions and training, and provides education to front desk staff across Shared Services, as needed. In addition, the IBCs will ensure consistency across all affiliates.

This position has responsibility across three NYS affiliates through Shared Services, including Planned Parenthood of Central and Western New York, Upper Hudson Planned Parenthood, and Planned Parenthood of the North Country.

Patient Screening

• For patients seen personally by the IBC, completes the full cycle of identification, enrollment, submission, and follow-up for patients eligible to be enrolled in appropriate government benefit programs
• Ensures the accuracy and completeness of applications taken by other center staff and assists patients and/or center staff in any manner required to fulfill the application submission requirements
• Represents the client in the application process and serves as liaison between the affiliate and the appropriate governmental entity
• Processes applicants’ recertification, terminations, and other inquires forthcoming from each Local Department of Social Services (LDSS) including determinations of ineligibility for processing errors by the LDSS
• Compiles monthly statistics to reflect the current status of applications received, processed, and finalized
• Attains the goal of number of new enrollees and reinstatements on a consistent basis as determined by Health Center Operations and Finance through the annual budgeting process
• Trains and evaluates health center staff on enrollment processes in collaboration with the Health Center Manager and Revenue Cycle Trainer
• Implements new programs or existing programs which can assist patients in obtaining insurance coverage for services
• Verifies patient insurance coverage to ensure necessary visits/procedures are covered by the payer; this is to include a review of high-ticket items to ensure any necessary prior approvals have been received
• Inputs accurate data to ensure that the patients benefit information is updated in the organization’s insurance systems, and verifies that existing information is correct to track and evaluate all aspects of the screening and enrollment process
• Works with patients to explain coverage amounts provided by their insurance policy and discuss financial obligations and payment options when necessary
• 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 across Shared Services as needed
• Works flexibly and cooperatively under supervision with all members of the health center staff to ensure maximum knowledge and support of the client

Insurance Follow-up

• Monitors status of all outstanding applications; follows-up on pending or incomplete applications in a timely manner
• Responsible for timeliness, accuracy, and completeness of documentation on patient accounts and follows-up with DSS and patients regarding enrollment status (i.e., CIN numbers, benefit cards, prescriptions, etc.)
• Processes all FPBP communications received
• Acceptance/Denials: enters all necessary insurance information in NextGen and notify the Billing Department of billable Date of Service (DOS), contact patient and document in NextGen
• Renewals: contacts patients, documents in NextGen, and checks for past DOS for billing and notify the Billing Department as necessary
• Discontinuation: completes notes in NextGen system and deactivates insurance by date specified on letter

Customer Service

• Builds and maintains positive, quality relationships with customers both internal (colleagues) and external (patients, clients, donors etc.)
• Demonstrates commitment to exceeding customer expectations at every opportunity
• Responds positively to customer

Other Accountability Activities

• Participates in Department of Health (DOH) training and other educational opportunities to keep current on regulations, requirements and processes
• Participates in affiliate initiatives
• Participates in and adheres to agency’s Compliance, Quality and Risk Management (CQRM) program
• Performs other duties as assigned
• Performs all functions in a manner that upholds Planned Parenthood of Central and Western New York (PPCWNY)’s mission, vision and values, as well as demonstrates commitment to providing services to a diverse range of clients

Applicants must possess the following qualifications (or equivalent combination of education and experience):

Education

• Associate’s degree in business, health care, or a related field; Bachelors preferred

Experience

• Minimum one year of experience in a healthcare setting; insurance coverage verification and/or billing preferred

Certificates, Licenses, and/or Registrations

• Certified Application Counselor (CAC) designation; certification must be obtained within six months of job acceptance (or at time of exam offering) if the candidate is not certified at the time of offer, registration for course work will be initiated immediately based on discussions with hiring manager.

Knowledge, Skills, & Abilities

• Knowledge of insurance guidelines and government programs (i.e., Medicaid)
• Must be proficient in Microsoft Office (i.e., Excel, PowerPoint and Word)
• Strong analytical and problem-solving skills
• Must demonstrate sensitivity toward patient’s financial and clinical needs, while maintaining the patient’s confidentiality
• Must be organized, able to prioritize tasks, and handle multiple projects
• Accuracy and attention to detail is essential
• Must be able to work independently and as a team player
• Must be able to multi-task and work in a fast-paced environment
• Exceptional communication skills (verbal and written) and interpersonal skills
• Must be able to multi-task and work in a fast-paced environment.
• Must be able to work a flexible schedule to support meetings and activities and travel to other sites
• Must have reliable transportation
• Planned Parenthood seeks candidates who are proficient in two or more languages

Working Conditions

• Standard health center environment
• Well-lit/ventilated

Physical Requirements

• Possess sufficient mobility to perform the Essential Functions listed in this Job Description with or without an accommodation
• Ability to lift 25 pounds with or without an accommodation
• May experience visual fatigue working at computer with potential extended periods of sitting
• Ability to travel to all agency locations as assigned

This is a full-time, 40 hour a week, position; regular schedule will be Monday – Friday with occasional evenings and weekends.

At PPCWNY, we are committed to equitable compensation practices and transparency. In alignment with these efforts, the pay for this position ranges from $20.37 to $23.58/hour. Actual compensation will be determined by experience and other factors permitted by law.

In addition to competitive compensation, PPCWNY offers an extensive benefits package with generous Paid Time Off, 10 paid holidays, affordable medical, dental, and vision options, Health Savings Account or Flexible Spending Account, 401(k) with match, and much more!