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Lead Benefits Coordinator in Remote at Family Health Center

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Family Health Center
Remote, United States
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Job Description

* This position will be located in WI. *


JOB SUMMARY

The Lead Benefits Coordinator is responsible for coordinating the day-to-day operations of the prepaid sliding fee program and serving as the lead resource for Benefits Coordinator staff. This position provides limited supervisory support, including monitoring daily workflows, assisting with staff training and onboarding, contributing to performance evaluations, and serving as the primary escalation point for complex member eligibility, enrollment, and benefit coordination issues. The Lead Benefits Coordinator ensures consistent application of program policies, maintains compliance with program requirements, conducts quality reviews, and supports reporting and process improvement initiatives. This position collaborates with internal departments and external partners to facilitate access to healthcare coverage options and assistance programs while ensuring accurate program administration. In addition, the Lead Benefits Coordinator serves as backup to the Financial Assistance Administrator and assists with financial assistance reviews and related activities as needed.


ESSENTIAL JOB FUNCTIONS

  • Conducts and reviews applicant interviews to explain covered benefits, member responsibilities, and program fee requirements while ensuring accurate and complete eligibility documentation.
  • Conducts outreach, enrollment, and eligibility activities for the prepaid sliding fee program and related assistance resources; serves as a primary resource for complex cases and provides guidance to staff regarding program requirements, procedures, and compliance standards.
  • Verifies member-reported changes, adjusts program fees as necessary, and conducts periodic audits to confirm ongoing eligibility and program compliance.
  • Oversees program fee payment processes, including initiating payment reminders, reviewing delinquent accounts, and negotiating payment arrangements with members as appropriate.
  • Delivers and promotes high-quality customer service by addressing and resolving inquiries or complaints from members, applicants, staff, and providers regarding eligibility, benefits, claims, and program requirements.
  • Maintains and updates member databases and reporting systems to ensure accurate tracking, reporting, communication, and data integrity; identifies discrepancies and works with appropriate staff to resolve issues.
  • Provides guidance to members transitioning to Medicare or other benefit programs (e.g., Low-Income Subsidy, SeniorCare) and facilitates coordination of new benefits.
  • Reviews applications, recertifications, and patient accounts to ensure completeness, compliance, and ongoing eligibility; provides backup coverage for the Financial Assistance Administrator.
  • Coordinates day-to-day workflow within the prepaid sliding fee programs by assisting with workload prioritization, identifying workflow issues, and supporting consistent application of program procedures. Conducts quality and compliance audits of program documentation and processes, identifies opportunities for improvement, and communicates findings and recommendations to management.
  • Trains, mentors, and supports staff in benefits eligibility, enrollment, prepaid sliding fee program administration and related patient assistance processes. Serves as a subject matter expert and resource for staff, providing guidance and coaching to promote accuracy, consistency, compliance, and excellent customer service.
  • Facilitates effective team communication by sharing information, coordinating workflow-related updates, participating in team meetings and collaboration efforts, and representing the department on assigned projects or initiatives. Promotes teamwork, consistency, and alignment with organizational and departmental goals.
  • Maintains strict adherence to scheduled work hours with regular and reliable attendance.
  • Performs other duties as assigned.


    • EDUCATION AND EXPERIENCE

  • High school diploma or equivalent.
  • Minimum of three years of experience as a Benefits Coordinator at Family Health Center.
  • Proficient in Microsoft Office Suite.
  • Knowledge of basic business math principles, including calculations and percentages with ability to interpret financial statements and tax returns


    • CERTIFICATIONS / LICENSES

  • Certified Application Counselor (CAC) designation through the Centers for Medicare and Medicaid Services required within three months of the first available CAC training period after hire. Employees hired fewer than three months prior to the CAC training period may defer certification until the following year. Preferred certification at time of hire.
  • Employees must pass the CAC certification exam within three attempts and within three months of completing training. Failure to pass may result in termination, except in cases of extenuating circumstances.
  • Valid Wisconsin Driver’s License required with an acceptable motor vehicle record (MVR), per FHC guidelines.
  • Preferred Wisconsin Accident and Health Insurance Agent License.

    • Equal Employment Opportunity

    Job Location

    Remote, United States

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