Job Purpose & Position Overview:

The primary purpose of this position is to function as the Patient Benefits Coordinator; assuring the identification of patients whom are eligible for any third party resources, that the patient meet eligibility criteria, including demographics and financial guidelines for the programs to apply for. Will be responsible for assisting patients with applications either paper applications or preferably online in real time applications. Make internal referral to the PHN for a home/hospital visits on any request or as needed basis for care; this referral can be either telephone or email and with the documentation of services in patients health record. Responsible for providing internal referral to CHR, PHN or Public Transit system for the transportation needs for patients. Will interpret rules and regulations for alternate resources to patients. If the patient does not meet any eligibility criteria, for third party resources, it shall be the responsibility of the PBC to print and scan the denial letter in the patients health record.

Specific Job Duties/Responsibilities:

• Act as an advocate for American Indian patients in securing alternate resources, such as Medicare, Medicaid, State Childrens Health Insurance Plan, Workmans Compensation, Third Party Liability, Department of Veterans Affairs, Market Place Insurance, ACA Obama Care Insurance, Childrens Special Health Services, etc.
• When a patient is identified as needing to apply for insurance, the PBC will assess what the patient may be eligible to apply for, if time allows, the PBC will apply online via computer or telephone to the appropriate agency. Once submitted, the PBC clerk will print out the result of the application, approved, pending or denied and scan into the patients health record and documented accordingly in RPMS. This insurance verification process will be reviewed prior to the patients outside referral going to PRC Committee.
• The PBC will identify a person who has no insurance and may be eligible for alternate resources by utilizing screening and interviewing methods effectively. Works closely with all facility staff in the identification and utilization of all alternate resources available to the American Indian population.
• Works closely with the Social Security Administration (SSA) on local and regional levels, local DHHS offices, all tribal offices to establish eligibility of insurance for patient needs. The PBC will set appointment times for the telephone interviews for the patient and schedule for the patient to be onsite if necessary. The PBC will set up transportation for the patient to come into the facility if needed for the telephone interview, etc.
• After patient check-in at patient registration, a referral to the PBC for Third Party eligibility. PBC will work with social services and all other disciplines to provide the patients needs are met. PBC will keep a register of eligible patients health status of the elderly and assists individuals with applications for alternate resources, providing internal referrals for transportation, making calls to CHR, PHN or Public transit for transportation, and interpretation of rules and regulations. Works closely with families, individuals, and agencies to ensure the patient does not encounter discrimination because of their dual role as a citizen and as an Indian Health Care recipient.
• If the patient has Medicare, Medicaid, Private Insurance or any other type of insurance coverage, the PBC will ask for the patients card. The patients card will be copied and scan into the patients Electronic Health Record. PBC will verify the insurance card the account number, the terms and effective dates and the ending dates, if any, before a referral for an outside provider goes to PRC Committee for approval. The patient shall be informed that not having the copy of the card in their chart can cause a delay in the referral process.
• If a patient does not comply and provide the facility with a copy of their Medicare, Medicaid or Private Insurance card, the patient will sign a waiver that they are willingly non-compliant with the rules and regulations of the facility and will be responsible for the cost of their visit.
• Patient Benefit Coordinator bi-weekly schedule will allow for one day only to schedule all out of office transports. This will allow the patients with no transportation to follow-up with SSD face-to-face interviews on the bi-weekly schedule. PBC will enter every transport in the patient health record.

Qualifications/Skills:

• Knowledge of and skill in applying an extensive body of Business Office rules and procedures concerning benefits programs such as Medicare/Medicaid, SSA, County DDS Offices, and Tribal programs and other related agencies to advocate for and assist patients in securing Third Party resources.
• Knowledge of the eligibility requirements for Medicare, Medicaid, and SSI to assist patients in seeking benefits. The ability and skill to interview patients in order to determine eligibility for alternate resources.
• The ability and skill to compile reports from various documents maintained within the Business Office.
• Knowledge of the Privacy Act of 1974 to maintain complete confidentiality of all administrative, medical, and personnel records, and all other pertinent information that comes to his/her attention or knowledge.
• Communication skills are required to effectively explain and solicit appropriate information from the patient.
• Valid drivers license and must be insurable.

Training Requirements:

• N/A

Physical Requirements:

• Normal to light office work which includes the ability to lift up to 10 lbs.
• Regularly required to walk, stand, and sit for extended periods of time and use hands to operate computer keyboard, phone, and various office equipment.
• While performing daily duties, the employee is regularly required to talk and hear.
• Operate a motor vehicle, due to duties, which may require bi-weekly transporting of patients.

Cognitive Requirements:

• Reading, writing, calculating
• Above average social interaction skills
• Reasoning/Analysis
• Works with minimal to no supervision

Language Requirements:

• Must possess the ability to read, write, and speak the English language fluently.
• Must be able to continually and effectively employ professional verbal and written communications skills.

Certificates, Licenses & Registrations:

• All applicants will comply with 45 CFR 1301, Subpart D, Section 1301.31, C and D, which require all prospective employees to sign a declaration prior to employment regarding all arrests and convictions of child abuse or violent felonies and to comply with PL 101-630 and PL 101-637 regarding criminal records check.

WCHS is an equal opportunity employer. Employment practices are free of discrimination. As provided by Federal Law, all qualified Native American applicants shall receive preference over Non-Native American applicants. In the absence of qualified Native American applicants, consideration will be given to all other applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, marital status, veteran status, genetic information, disability or any other reason prohibited by law in provision of employment opportunities and benefits.

Please note the position description duties, responsibilities, and activities may change at any time with or without notice.