Job Summary:

This position is responsible for leading the Sponsorship program offered by the Oyate Health Center (OHC), including establishing and managing the Sponsorship program as well as integrating these efforts with other Patient Benefits Coordinator activities. These are designed to advocate for patients in the effective utilization of alternate resources and ensure that all patients who are eligible for alternate resources are identified, contacted and encouraged to apply for and maintain eligibility for available benefits. The position is also responsible for supervision of the entire OHC Patient Registration Department. The position oversees the day-to-day operations of the patient registration functions. Oversight includes patient registration activities in primary care, urgent care, pediatrics and specialty care areas. Position will also offer expertise to other divisions where patient registration is utilized such as behavioral health, dental, optometry, and other specialty areas as needed.

Essential Functions:

• Direct the planning, implementation, management, and evaluation of the Sponsorship program, including patient enrollment and subsequent enrollee assistance activities pertaining to Sponsorship through the Marketplace (and potentially Medicare), and integrate Sponsorship enrollment activities with Medicare and Medicaid eligibility determination and enrollment.
• Direct the planning, scheduling and daily activities of the OHC Patient Registration areas.
• Ensure all registration areas will obtain, update, and verify eligibility services by interacting with patients to process demographic and insurance information.
• Serves as the subject matter expert in determining eligibility of patients seeking healthcare who have not been treated at the facility by obtaining proof of tribal membership or descendancy.
• Develops and maintains system of documents or records required for direct care service eligibility.
• Acquire and maintain knowledge of the Affordable Care Act (ACA) and the Marketplace.
• Acquire and maintain knowledge of Medicare and Medicaid.
• Establish procedures for Marketplace and Sponsorship program eligibility determinations, payment of enrollee premiums, on-going enrollee education and assistance, and education of GPTCHB and OHC leadership, staff, and community members on the Sponsorship program.
• Develop and maintain training programs for staff members interacting with the Sponsorship program as needed to comply with federal and state requirements and to effectively identify and enroll eligible individuals.
• Prepare written materials, such as educational materials, program procedures, and program evaluation reports.
• Develop overall program goals, performance measures, and standards.
• Review and evaluate the performance of Patient Registration & Patient Benefits Coordination staff members on a regular basis, and ensure overall program performance meets pre-established goals and objectives.
• Develop and manage the program budget in an efficient and effective manner designed to achieve Sponsorship program goals.
• Provide monthly reports to OHC leadership and Sponsorship program staff, pertaining to the development, management, and evaluation of the program.
• Monitor the timeliness and effectiveness of program activities.
• Maintain effective working relations with GPTCHB and OHC staff members, colleagues, and other key stakeholders inside and outside of the organization, including county, state and federal partners.
• Handle conflict resolution with good judgment, professionalism, and courtesy.
• Supervise and provide direction to staff; interview and hire staff, evaluate performance on regular basis; manage time and attendance; implement disciplinary action when needed.
• Plan coverage accordingly for the patient registration sections as facility operation hours are needed and adjusted. Will plan schedule of staff to include evening and weekend hours on a rotating basis.
• Must comply with federal laws and regulations as required by the Health Insurance Portability and Accountability Act (HIPAA).
• Performs related duties.

Other Essential Benefits Manager-related Functions:

• Determine eligibility of patients and ensure appropriate identification of patients who have or are eligible for direct services.
• Determine eligibility of patients and ensure maximal identification of patients who have or are eligible for alternate third-party resources by effectively implementing screening and interview methods.
• Review Purchased Referred Care (PRC) referrals and verify patients’ eligibility for services.
• Participates as an active member of the PRC CHEF (Catastrophic Health Emergency Fund) Committee on a monthly basis. Directs benefits staff and ensures follow up of CHEF cases are completed in a timely manner for reimbursement for PRC funds or submission of CHEF requests.
• Ensures any application approved is modified and correspondence provided to each member of the CHEF committee and also business office staff to capture all entitled revenue for direct care services provided.
• Work closely with all facility staff in identification and proper utilization of all alternate resources available to all patients.
• Develop system of identifying uninsured patients and assigning work through tangible reportable metrics through the use of patient registration and benefits monthly reports.
• Assist OHC Business Office with claims identified as being denied by an insurer due to a patient registration error. Ensures that these errors are corrected timely within appropriate timely filing limits to promote optimal reimbursement for revenue generation.
• Develop and maintain a network of contacts in local, state, tribal and federal agencies to better assist patients in developing other resources, including all agencies and organizations that provide alternate resources for health care.
• Follow up on all pending eligibility cases and work closely with families and agencies until completion of application.
• Work with patients to appeal denials from third resources as applicable.
• Work closely with medical staff to obtain pre-authorization for services.
• Document all encounters and work activities on finding/maintaining alternate resources; update patient’s electronic record; provide monthly reports to supervisor.
• Continually research all alternate resources, exploring all available options for patient coverage; ensure application and information on alternative resources are readily accessible to the patients.
• Assist patients and their families with processing all applications for alternate resources. Provide interpretation of the rules and regulations from the organization supplying the benefit, as well as the rules governing Tribal/IHS services. Review with patients what is covered and how to use those services.
• Serve as back up for Patient Registration and other position as directed.
• Works with Patient Registration staff of all areas to ensure proper MSP (Medicare Secondary Payer) forms are completed correctly for compliance with CMS.
• Readily accept referrals from Patient Registration to assist patients.
• Comply with federal laws and regulations as required by the Health Insurance Portability and Accountability Act (HIPAA) and the Privacy Act of 1974.
• Organize community enrollment events and actively participate in other community programs events.

• Perform related duties as assigned.

Professional Behavior

• Effectively plan, organize workload and schedule time to meet the demands of the position.
• Work in a cooperative and professional manner with OHC and GPTCHB staff.
• Treat Great Plains tribes and collaborators with dignity and respect.
• Utilize effective verbal and written communication skills.
• Advance personal educational development by attending training sessions and seminars as appropriate.
• Exemplify excellent customer service with tribal stakeholders, health board colleagues, program partners, service recipients, visitors and guests.
• Foster a work environment of wellness, courtesy, friendliness, helpfulness and respect.
• Relate well and work collaboratively with coworkers and all levels of staff in a professional manner.
• Consistently demonstrate respect for and acceptance of differing capabilities, cultures, gender, age, sexual orientation and/or personalities.
• Maintain and ensure organizational privacy and confidentiality.
• Handle crisis and tolerate stress professionally.
• Be self-directed and take proactive initiative to assist others.
• Resolve issues with other departments and coworkers without direct supervision if needed.
• Exercise flexibility to alter plans/routines when situations require and continue to perform without projecting stress/frustration that would adversely affect the work environment.
• Promote an alcohol, tobacco and drug-free lifestyle.
• Embrace modes of appearance and attire that reflect a professional presence.
• Adhere to GPTCHB policies and procedures.

Requirements

• Ability to acquire and maintain expertise in the opportunities and requirements involving Sponsorship through the Marketplace, as well as other health insurance Sponsorship options.
• Knowledge of policies, standards and procedures for determining those persons who fall within the scope of the Indian Health Service (IHS) and Tribal Health Programs definition of direct care eligible individuals for health services.
• Knowledge of and ability to apply alternate resources regulations.
• Knowledge of various third-party payers, applications processes, and eligibility requirements.
• Knowledge of computers and job-related software programs and office equipment.
• Knowledge of customer service principles.
• Ability to work with personal computer and utilize a variety of software applications.
• Ability to communicate clearly and effectively, both orally and in writing.
• Ability to effectively meet and communicate with the public.
• Ability to organize the multiple demands of the job.
• Ability to drive a motor vehicle in adverse weather conditions.
• Skill in providing exceptional customer service.
• Skill in prioritizing and planning.
• Skill in interpersonal relations.
• Skill in the maintenance of files and records.
• Skill in the use of such office equipment as a computer, scanner, fax machine, and copier.
• Skill in oral and written communication.

Supervisory Controls

The supervisor sets the overall objectives and resources available. The employee and supervisor, in consultation, develop deadlines, projects, and work to be done. The employee is considered an expert and is responsible for planning and carrying out the assignment, resolving most of the conflicts that arise, coordinating the work with others as necessary, and interpreting policy on own initiative in terms of established objectives. In some assignments, the employee also determines the approach to be taken and the methodology to be used.

The employee keeps the supervisor informed of progress and potentially controversial matters. Completed work is reviewed only from an overall standpoint in terms of feasibility, compatibility with other work, or effectiveness in meeting requirements or expected results.

Guidelines

Guidelines are available but are not completely applicable to the work or have gaps in specificity. The employee must use judgment in interpreting and adapting guidelines, such as agency policies, regulations, precedents, accreditation requirements, advanced clinical protocols, and work directions for application to specific cases or problems. The employee analyzes results and recommends changes. The employee uses initiative and resourcefulness in deviating from traditional methods or researching trends and patterns to develop new methods, criteria, or proposed new policies.

Guidelines include GPTCHB, OHC, and department policies and procedures. These guidelines are generally clear and specific, and deviations must be authorized by the supervisor.

Complexity/Scope of Work

The work typically includes varied duties that require many different and unrelated processes and methods, such as those relating to well established aspects of an administrative or professional field. Decisions regarding what needs to be done include the assessment of unusual circumstances, variations in approach, and incomplete or conflicting data.

The work involves treating a variety of conventional problems, questions, or situations in conformance with established criteria. The work product or service affects the design or operation of systems, programs, or equipment; the adequacy of such; the social, physical, and economic well-being of people; or the social or economic well-being of the organization. This level of scope and effect is typically representative of work performed by para-professionals, clinical professionals, administrative specialists or technicians, and skilled trades positions within the organization.

Contacts

The personal contacts are with individuals or groups from outside the organization in a moderately unstructured setting. For example, the contacts are not established on a routine basis and the purpose and extent of each contact is different. Contacts are typically with clinical providers, patients/family members, employees, community resource agencies, various Health Departments, Tribal Health programs, and the general public.

Contacts are primarily for obtaining, furnishing, exchanging and providing factual medical information.

Work Environment/Physical Demands

The environment involves everyday risks or discomforts that require normal safety precautions typical of such places as offices, meeting and training rooms, requiring use of safe work practices with office equipment, avoidance of trips and falls, observance of fire regulations and traffic signals. The work area is adequately lighted, heated, and ventilated.

The work is sedentary. Typically, the employee sits comfortably to do the work. However, there may be some walking; standing; bending; carrying of light items, such as papers, books, or small parts; or driving an automobile. The employee must be able to read, write, speak and hear.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Supervisory and Management Responsibility

This position is a first level supervisor and is usually responsible for the work performance of a small group of employees or a larger group with a homogeneous objective (i.e., employees all perform same basic type of work). The employee is responsible for planning, organizing and monitoring day-to-day work on a short-term cycle. This position assigns work to subordinates, adjusts workflow to maintain balance among positions and meet priorities or deadlines, and makes minor changes in structure, methods, or procedures as necessary to accommodate changes in work pattern, emphasis, or capability. The employee carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Minimum Qualifications

• Bachelor’s degree and three (3) years of progressively responsible relevant experience, or an associate’s degree and five (5) years progressively responsible experience, or a high school diploma or GED and seven (7) years of progressively responsible experience. The experience required for supervisory positions will be inclusive of at least one (1) year of supervisory/management experience.
• Demonstrated ability to acquire and master complex subject matter.
• Demonstrated ability to manage a program’s activities and to manage or successfully coordinate with other staff.
• Three (3) years of related experience to understand and perform the major duties of the position, and to be able to answer questions and resolve problems.
• Two (2) year supervisory experience.
• Must successfully pass a criminal and background check, and a pre-employment drug screen.

The GPTCHB is a tribal organization which follows tribal preference laws. It is our policy to give preference to qualified Indian/Tribal candidates over qualified non-native candidates in hiring decisions, if all other qualifications are equal.

Employment is contingent upon the outcome of all required criminal background checks.

To Apply

To apply, please complete the online employment application found at www.gptchb.org.

For questions, please contact Human Resources at hr@gptchb.org.

Upon Hire

I acknowledge that this job description is neither a contract of employment nor a legal document. I have received the job description and I understand that it is my responsibility to read and comply with the duties contained in this description and any revisions made to it.

Employee Signature: ___________________________________ Date: _________________

Supervisor Signature: __________________________________ Date: _________________