Salary: $52,067.00 - $68,987.00 Annually
Location : Scottsdale, AZ
Job Type: Full-Time
Job Number: 100741-240416
Department: Health & Human Services
Opening Date: 04/16/2024
Closing Date: 4/30/2024 11:59 PM Arizona
Definition
Under general supervision of the Benefits Coordination Manager, assumes primary responsibility for the HHS Billing Program benefits coordination including all enrollment and program reporting. Acts as the primary resource for enrollment and continuously focuses on increasing participation in the HHS Billing Program. Identifies qualified clients for enrollment eligibility in order for them to receive services and benefits that qualify for the Arizona Health Care Cost Containment System (AHCCCS) reimbursements to the Community. Assists eligible clients with initial AHCCCS applications and enrollment then monitors and re-enrolls after periods of AHCCCS ineligibility. Uses the utmost discretion, privacy and confidentiality in protecting client and program information. This job class is treated as FLSA Non-Exempt. This is a job progression position.
Essential Functions : Essential functions may vary among positions and may include the following tasks and other characteristics. This list of tasks is ILLUSTRATIVE ONLY and is not intended to be comprehensive listing of tasks performed by all positions in this classification.
Examples of Tasks
1. AHCCCS Enrollment: Utilizes all available methods to identify eligible clients for enrollment in the AHCCCS thru the HHS Billing Program.

• Ensures all eligible and willing client participants stay enrolled in the program.
• Acts as part of an integral system that provides client intake needs assessment, counseling services and AHCCCS billing at no cost to the client.
  1. Includes maintaining eligibility vigilance, initial enrollment and then re-enrollment after unqualified periods due to quarterly Community Member per capita payments or other income disqualifying circumstances.
• Develops and continually improves a set of processes, procedures and standards to enhance the enrollment program. This includes, but is not limited to, the following:
  1. Eligibility Screening: Develops tools and criteria for program participation
  2. Income Qualification: Includes income verification, pay stubs, etc.
  3. Application: Assists clients with initial enrollment and re-enrollment
  4. Monitoring: Tracks participant eligibility status
• Constantly monitors the Management Accountability Information SystEm ("MAISE") client base and "Eligibility Summary" for enrollment status and determination of eligibility.
• Monitors Medicare eligibility as it related to participation in the program.
• Interviews recipients and assists with gathering all pertinent information to complete applications for the application process.
  1. Tracks and assists clients throughout the application process and provides customer service beyond the initial application phase.
  2. Monitors completion of financial information forms and obtains verifications as necessary.
• Prepares for re-enrollment during periods of ineligibility due to per capita payout or other disqualifying circumstances. Ensures re-enrollment in a timely manner in order to maximize claims reimbursement to the Community.
• Partners with the Intake Assessment and Crisis Management staffs in a team approach to identify eligible and willing participants for the program.
• Interfaces with the HHS Behavioral Health Director, Behavioral Health Counselors and Community Health Representatives to review case files and determine those clients eligible for AHCCCS and the HHS Billing Program.
• Contacts potential clients to discuss program benefits and available enrollment assistance.
• Researches benefits related issues, concerns and works to resolve problems.
  1. Recommends courses of action for problem resolution.
  2. Helps solve Per Capita & eligibility problems relating to program participation.

2. Community Outreach, Program Education & Communication: Works diligently to promote and educate the Community about the services and benefits of enrolling in the HHS Billing Program.

• Utilizes all available resources to inform and educate potential clients about the program including, but not limited to, health fairs, flyers, direct mail-outs, newspaper articles, advertisements, electronic signage, payroll stuffers, etc.
• Highlights the benefits of enrollment including no cost to clients and the financial benefit to the Community.
• Develops creative and innovative methods to educate and communicate with potential program participants.
• Meets one-on-one with individuals or with family group members to explain the ease of program participation and enrollment along with the help available in order to promote the program.
• Provides program benefits information and training to staff as required.

3. Reporting & Administration: Assumes primary responsibility for the HHS Billing Program benefits coordination, enrollment and reporting.

• Adheres to all department and AHCCCS related documentation requirements.
• Generates benefits related reports as necessary to document program metrics and participation.
• Maintains an accurate and up-to-date database of client participants and potential participants including eligibility status, dates, contact information, etc.
• Updates and maintains all participant files to ensure accurate client information.
• Develops and updates the benefits program policies, practices, procedures and methods to provide a uniform set of program guidelines.
• Works with other department staff and outside partners to bring value to participants and the program.
• Analyzes program enrollment trends and reports to the Benefits Coordination Manager as necessary.
• Protects client personal privacy, security and program confidential information in compliance with the Health Insurance Portability and Accountability Act (HIPAA).

4. Miscellaneous: Performs other job related duties as assigned by the Benefits Coordination Manager or HHS Director.
Knowledge, Skills, Abilities and Other Characteristics:

• Knowledge of the history, customs, culture and traditions of the Salt River Pima-Maricopa Indian Community.
• Knowledge of generally accepted benefits administration practices and methods.
• Knowledge of the AHCCCS benefits eligibility requirements and enrollment procedures.
• Knowledge of customer service principles.
• Knowledge of the SRPMIC Per Capita system.
• Knowledge of HIPAA compliance standards.

• Skill with accurate and timely record-keeping plus accessing and retrieving database information.
• Skill maintaining accurate client benefits information and files.
• Skill establishing and maintaining effective working relationships at all levels of the organization and with outside benefits partners.
• Skill researching a variety of information and problems pertaining to benefit matters.
• Skill with a personal computer including MS Office and MAISE software. Proficiency with MS Excel spreadsheets is critical.
• Skill with verbal and written communication and interpersonal skills.
• Skill working with minimal supervision.

• Ability to use creative marketing strategies to maximize Community outreach.
• Ability to meet with clients to patiently, easily but thoroughly explain the benefits program and processes.
• Ability to interact effectively as a team member with management and line staff.
• Ability to be a self-starter and manage time and workflow efficiently.
• Ability to perform detailed work for prolonged periods.
• Ability to use discretion and judgment when dealing with client and program confidential information.

Minimum Qualifications
Education: High School Diploma or equivalent.

• For enrolled Community Members without a GED, must obtain a GED. Requires participation in the HR GED Program and successful completion of the Arizona state certified exam in order to continue employment with SRPMIC.
• An Associate's degree from an accredited college or university is preferred.
• Certified Benefits Professional (CBP) highly preferred.

Experience: Two (2) years healthcare industry benefits administration experience preferred but not required.

• Demonstrated successful experience with accurate data entry and report generation required.
• MS Office proficiency, with an emphasis on MS Excel, required.
• AHCCCS related experience highly preferred.
• Benefits related experience with low income population highly preferred.
• Experience working in some capacity with SRPMIC Community Members highly preferred.

Equivalency : Any equivalent combination of education and experience that will allow the applicant to satisfactorily perform the duties of the job may be considered.
Underfill Eligibility: An enrolled Community Member whom closely qualifies for the minimum qualifications for a position may be considered for employment under SRPMIC Policy 2-19, Underfill
Special Requirements

• May be required to work outside normal work hours including nights, weekends and holidays.
• Employees in, and applicants applying for, jobs providing direct services to children are subject to the "Community Code of Ordinances", Chapter 11, "Minors", Article X. "Investigation of Persons Working With Children".

Prior to hire as an employee, applicants will be subject to drug and alcohol testing. Will be required to pass a pre-employment background/fingerprint check.
"SRPMIC is an Equal Opportunity/Affirmative Action Employer" Preference will be given to a qualified: Community Member Veteran, Community Member, Spouse of Community Member, qualified Native American, and then other qualified candidate.
In order to obtain preference, the following is required: 1) Qualified Community Member Veteran (DD-214) will be required at the time of application submission 2) Qualified Community Member (must provide Tribal I.D at time of application submission),3) Spouse of a Community Member (Marriage License/certificate and spouse Tribal ID or CIB is required at time of application submission), and 4) Native American (Tribal ID or CIB required at time of application submission).
Documents may be submitted by one of the following methods:
1) attach to application
2) fax (480) 362-5860
3) mail or hand deliver to Human Resources.
Documentation must be received by position closing date.
The IHS/BIA Form-4432 is not accepted.
Your Tribal ID/CIB must be submitted to HR-Recruitment-Two Waters.
The SRPMIC offers a comprehensive benefit package including medical, dental, vision, life, disability insurance, and a 401(k) retirement plan. In addition employees enjoy vacation and sick leave and 13 paid holidays.