Patient Benefits Coordinator/PRCRC bei Iowa Tribe of Oklahoma

Description

Summary of Responsibilities:

Responsible for assuring the identification of patients who are eligible for alternate resources. This position will assist in making applications for alternate resources such as Medicare, Medicaid, and third party billing with various State, Federal, and Tribal agencies. This position works closely with the Social Security Administration to assist potential eligible patients for Medicare, also with the County Department of Human Services and Tribal offices. This position also works closely with patient registration in screening follow-up on all pending eligibility claims and continually researches and updates pertinent information. This position has no supervisory capacity.

Requirements

Essential Duties and Responsibilities:

• Assists in making applications for alternate resources (Medicare, Medicaid, third party payers, and private insurance).
• Answers phone calls.
• Processes any incoming mail regarding eligibility.
• Maintains filing system for eligible patients and those who do not qualify.
• Updates all information in EHR system.
• Works closely with the intake desk and the business office.
• Communicates, educates patients regarding Contract Health Services/Purchase and Referred Care mandatory requirements.
• Assist patients to identify and enroll in alternate benefits and assist patient in using those benefits. Coordinate referrals for patients to specialist providers, assure adherence to CHS rules and jurisdictional boundaries. Position directs patient to appropriate resources if eligibility requirements are met.
• Works closely with the Medical Provider, patient registration staff and other facility staff to ensure maximum identification of persons who are eligible to receive alternate resources.
• Responsible for tracking and follow-up activities of each referral as the patient progresses through the CHS system. Monitors status of all CHS requests to their completion.
• Maintain open channels of communication and clear flow of information between all appropriate PFC providers, PFC administration and all relevant facilities.
• Administer complete and accurate documentation of referral and process in PFC’s electronic health records (EHR).
• Assist families and individuals in application through other agencies which provide alternate resources.
• Determine and establish eligibility of Medicare, Medicaid, Aid to Families with Dependent Children (AFDC), Supplemental Social Security Income, etc. on patients by working with the Department of Human Services (DHS), Social Security Administration on local and regional levels, tribal offices and/or other appropriate agencies.
• Participate in training clinic staff regarding patient referral system procedures and processes.
• Assists in processing ER and hospitalization call-ins and/or walk-ins.
• Assists CHS/Purchase and Referred Care with fiscal year reports as needed.
• Performs other duties as required.

Education and Experience:

• Associate’s Degree in medical office technology or related field preferred
• High School diploma or equivalent.
• Experience in a medical setting.
• Experience with insurance and medical billing.
• Experience with Electronic Health Record preferred.
• Experience and knowledge of Medicare/Medicaid, Social Security Administration, County DHS Offices, tribal programs, and other agency policies, procedures, and eligibility requirements.
• One year experience working with medical service providers in a Contract Health referral position.

Knowledge, Skills and Abilities:

• Ability to interview and/or screen patients to determine eligibility
• Knowledge of benefits offered through third-party resource programs such as Medicare, Medicaid, VA, tribal benefits packages and other resources, etc. available to eligible patients.
• Knowledge of the Health Insurance Portability and Accountability Act (HIPAA) in regard to confidentiality and the release of medical information.
• Skill and ability to organize and multi-task – ability to prioritize tasks by importance and accomplish highest priority tasks each day.
• Ability to communicate courteously and effectively with third party billing representatives, co- workers, medical care providers, management personnel, tribal leaders and the general public both orally and in writing.
• Ability to work with others on an individual basis utilizing high interpersonal skills.
• Must be able to read, understand, apply and retain knowledge of departmental rules, regulations, and policies.
• Outstanding organizational abilities and must be able to prioritize.
• Naturally possess a welcoming and outgoing personality.
• Proficient use of Microsoft Office applications (Word, Excel) and internet resources.

Conditions of Employment:

The Iowa Tribe of Oklahoma operates a drug-free workplace.

• Must submit to and pass applicable drug test.
• Must pass background investigations for suitability of character identified in accordance with the Indian Child Protection and Family Violence Prevention Act.
• Annual TB skin test, proof of previous positive PPD results or negative chest X-ray.
• Hepatitis A & B, Tdap, MMR and Varicella vaccinations, proof of previous vaccinations or proof of positive titer.