POSITION TITLE: Patient Benefits Coordinator I

CLASSIFICATION: Non-Exempt

DEPARTMENT: Tribal Health

SUPERVISOR: Purchased/Referred Care Manager

GRADE: NE9 $17.84 ($37,107.30) – $26.76 ($55,660.80)

Position Summary:

Under direct supervision the Patient Benefits Coordinator I is responsible for providing leadership and advocacy on the behalf of patients by assisting in the obtaining of approval and utilization of benefit programs and alternative resources in coordination with the policies of Tribal Health. Maintains HIPAA confidentiality of all privileged information.

Essential Duties & Responsibilities:

• Determines patient eligibility for Direct Care and/or Purchased Referred Care.
• Identifies patients who have or are potentially eligible for alternate resources.
• Assures maximum identification by implementing effective screenings and interviewing methods.
• Works closely and cooperatively with Administrative and Clinical staff in identifying and utilizing all alternate resources available to Health Center patients.
• Conducts personal in-depth patient interviews to determine eligibility for alternate resources and enrolls patients in third party payor insurance plans
• Registers, enters, and updates patient demographics, health insurance, and employer information data into the EHR patient registration system.
• Follows up with patients regarding Medicare, Medicaid, Medi-Cal, and private insurance changes, terminations, and eligibility.
• Verifies alternate resource eligibility for Direct Care and Purchased Referred Care.
• Stays knowledgeable of alternate resource eligibility requirements and their processing application.
• Answers telephone and personal inquiries regarding patient registration and patient benefits coordination and PRC compliance issues.
• Follows up with patients and/or tribal offices regarding tribal enrollment and verification.
• Provides patient education regarding patient registration, patient benefits coordination, alternate resources program requirements, and Purchased Referred Care compliance.
• Performs audit of patient’s files to ensure all needed forms are present.
• Performs other duties as required.

Minimum Qualifications:

• High School Diploma or GED and two years experience in a medical office setting; or equivalent combination of education and experience.
• Preference will be given to Qualified Native Americans.

Knowledge, Abilities, Skills, and Certifications:

• Knowledge of records management and basic accounting procedures.
• Knowledge of medical/dental terminology preferred.
• Knowledge of Medicare, Medicaid, Social Security, federal health care legislation including Champus and the Indian Health Care Improvement Act provisions.
• Ability to communicate effectively in the English language both verbally and in writing.
• Ability to establish and maintain professional relationships with individuals of varying social and cultural backgrounds and with co-workers at all levels.
• Ability to represent the organization professionally, building respect and confidence.
• Ability to maintain confidentiality.
• Ability to handle multiple tasks and meet deadlines.
• Ability to carry out instructions furnished in verbal or written format.
• Ability to work independently with minimal supervision.
• Skill in operating business computers and office machines, in a MS Office environment, specifically Word, Excel, Access, and presentation software (such as PowerPoint).
• Knowledge of EHR systems (NextGen, Epic, tc.)

Physical Demands:

While performing the duties of this job, the employee regularly is required to sit; use hands to finger, handle, or feel; reach with hands and arms, and talk or hear. The employee frequently is required to walk. The employee occasionally is required to operate a motor vehicle; stand, stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds.

Work Environment:

Work is generally performed in an office setting with a moderate noise level.

The Washoe Tribe of Nevada & California requires a background check of each new hire for employment purposes. Therefore, all conditionally offered positions will be subject to the following:

• Negative alcohol and drug screen
• Meet requirements of Public Law 101-630
• Obtain or possess a valid driver’s license for either the State of Nevada or California within 30 days
• Must be insurable under the Washoe Tribe’s driving policy