PG191204SP

No

Insurance Coordinator

Commensurate with experience

Monday-Friday 8:00am-5:00pm with nights and weekends as needed

Raleigh, NC

Athletics - Sports Medicine

The Sports Medicine Department provides comprehensive healthcare under the direction of our team physicians for approximately 600 student-athletes spanning twenty-four (24) sports. This office provides services to our student-athletes to assist them in the referrals process to medical providers on and off campus thereby guiding them in proper medical care.

Coordinates the administration of Health Care for over 600 Student-Athletes. This includes medical records, cost containment, budget control, organization, and administration of 20 licensed Athletic Trainers, Consulting Team Physicians, 2 Dieticians, 3 Psychologists, and other allied health professionals holding clinics in the three Sports Medicine Facilities on campus.

In order to fulfill the goals of the department this position must possess knowledge and understanding of the insurance avenues available and utilize the rules of each to make a prioritized judgement of the best avenue for each referral. This position must carry out the medical referral process while coordinating and keeping with the administrator’s commitments to the health and welfare of each student athlete and the financial goals and limitations of the department. This position must possess a full understanding of the implications of the insurance market in all 50 states as well as an understanding of the PPO/HMO/POS of each student-athlete’s insurance policy or have the ability to investigate the same in a rapid time frame for emergency situations. After investigating and reviewing insurance options, medical treatment, timeline and other external factors this position determines the best option for proceeding with treatment in keeping with their insurance limitations, the department’s budget limitations and other independent external factors.

Oversee budget with recommendations to pricing for use of medical care. Will be responsible for making recommendations with regards to the best choice of medical care within the financial parameters of the program and the student-athletes’ personal resources. Work with the insurance company to minimize departmental costs. Obtain pre-authorizations, manage different levels of appeals and review invoices to maximize the claims payment by the primary carrier. Managing the process can result in savings for the Athletic Department of hundreds of thousands of dollars annually. Will coordinate with the Compliance Office to determine the qualifications for purchase of Medical Coverage for those student athletes that have a need. Review and approve all expenditures for the Sports Medicine Budget into the accounts payable system through the Athletic Business Office System.

Consults with student-athletes and parents/guardians to determine the best insurance coverage for students. Consults with Physicians, Athletic Trainers, Insurance Companies to determine best time, method to seek medical care in regards to insurance approvals and stipulations. Consult with student-athletes and coaches to coordinate schedules to best set up medical appointments and procedures.

Due to University hard waiver requirements this position has developed a process for the Athletic Dept. to determine the most appropriate insurance coverage for the individual student-athlete. The Athletic Dept. requirements are more stringent for student athletes than for the general student population. This position will gather all information on approximately 600 student-athletes, analyze and verify what meets minimum requirements. Will monitor the waiver process to ensure that all students are appropriately classified. Analyze and determine the best facility/provider to seek care from in regards to insurance network stipulations. Negotiate fees or discounts with external providers. Coordinate team, class, provider and student-athlete schedules for medical appointments. Anticipate unusual expenditures and concerns and alert Sports Medicine Director.

Works with community providers to persuade and negotiate timely appointments. Communicates effectively with community providers to build a trust and commitment with regard to the Sports Medicine Department’s financial assurance of payment of claims and services. Will serve on Departmental and Campus Staff Committees when available as a voice of the Sports Medicine Department. Will be available to explain in detail the Sports Medicine Department’s policy on payment of athletic services. Often these are difficult conversations with parents/guardians so require empathy, tact and diplomacy. Will work with all parties to come to an agreeable resolution in keeping with the Sports Medicine Department’s Mission. Will independently research student-athletes insurance coverage and develop a plan that best suits the athlete and the goals of the department. Will compose a request for medical authorization request(s) from Primary Care Providers, Insurance Companies or their appointed authorization representatives. This action will be initiated and completed independently. Will review and edit policies from Insurance and Risk Management for adequate coverage.

Supervise one administrative support staff and one associate insurance coordinator. Responsible for hiring decisions, performance management, training, employee relations and work distribution. Coordinate duties with staff and graduate students in regards to medical records, to ensure that all procedures and policies are being followed.

Other duties as assigned by Asst. Athletic Director for Sports Medicine and Administration.

Bachelor’s degree and one year of experience related to the area of assignment; or equivalent combination of training and experience.

All degrees must be received from appropriately accredited institutions.

• Prior experience in medical office billing or scheduling.
• Knowledge and understanding of ALL health plans including but not limited to PPO/HMO/POS/NON PPO policies in the United States and Internationally.
• Full understanding of HIPAA rules as they apply to the protected health information of our student-athletes and staff for departmental guidance and recommendations.
• Knowledge of precertification process for medical procedures including but not limited to MRI / CTScans / BoneScans / Surgeries. Uses judgement for the best approach in obtaining authorization for services req. for the best health and welfare of athletes.
• Knowledge of Excel program and NCSU Financials for the administering of budget items in the Sports Medicine Budget (medical and otherwise). Use of the Excel/Access Program for tracking of Student-Athletes medical expenditures.
• Ability to review complete insurance packages for each athlete and make a recommendation for optimum choice in medical facilities for non-emergent care.
• Ability to review the current market of medical care and charges for the purpose of recommending changes in avenue of care for all student-athletes.
• Ability to resolve financial conflict through negotiation(s) with providers. Ability to negotiate/compromise a financial fee for service with keeping the departments’ goals intact.
• Ability and willingness to reach an agreeable resolution in keeping with good working relationships within the community of exclusive providers.
• Ability to communicate with the Sports Medicine Staff and Dept staff and administrators.
• Must be able to interpret policy information given in a written and a verbal form.
• Must be able to convey the policies of the Sports Medicine Department in a clear and indisputable format.

• Minimum of five years experience in medical office management.
• Notary.

n/a

No

No

06/18/2021

06/24/2021

Please attach resume and contact information for 3 references.

00046837

SHRA

University Program Specialist

Journey

$31,888 - $80,223

70

If no applicants apply who meet the required competency level and training & experience requirements, then management may consider other applicants. Salary would be determined based on competencies, equity, budget, and market considerations.

1.0

12 Month Recurring

Non Mandatory - Adverse Weather

Non Mandatory - Emergency Event

No

No

106001 - Athletics-Student Welfare & Development

NC State University is an equal opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, gender identity, age, sexual orientation, genetic information, status as an individual with a disability, or status as a protected veteran.

If you have general questions about the application process, you may contact Human Resources at (919) 515-2135 or workatncstate@ncsu.edu. Individuals with disabilities requiring disability-related accommodations in the application and interview process, please call 919-515-3148.

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