What are the responsibilities and job description for the Patient Benefits Coordinator position at ctclusi?
Job Description:
PRINCIPAL ACTIVITIES & RESPONSIBILITIES
- Determine the 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.
- Work closely with all facility staff in identification and proper utilization of all alternate resources available to all patients.
- 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 claims and work closely with families and agencies until completion of application.
- Work with patients to appeal denials from third resources as applicable.
- Works 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.
- Serves as back up for Patient Registration and other positions as directed.
- Readily accepts referrals from Patient Registration to assist patients.
- Must comply with federal laws and regulations as required by the Health Insurance Portability and Accountability Act (HIPAA) and the Privacy Act of 1974.
- Performs related duties as assigned.
- Participate in community enrollment events and actively participate in other community programs events.
JOB LOCATION
Three Rivers Health Center
150 S. Wall Street
Coos
Bay, Oregon 97420
Apply online @
www.ctclusi.org
Open until Filled
