Patient Benefits Coordinator (Outreach/Home Visit)

Description

Under general supervision of the Patient Benefits Supervisor, the Patient Benefits Coordinator (Outreach/Home Visit) is responsible for maximizing use of alternate resources in order to support collections for payment to the facility and its satellite clinics for direct care visits and to minimize Purchased Referred Care costs for referred care. Uphold the principles of WIHCC’s Vision, Mission, and Value Statements. Maintains confidentiality of all privileged information at all times.

This list of duties and responsibilities is illustrative only of the tasks performed by this position and is not all-inclusive.

Essential Duties & Responsibilities:

• Maintains regular attendance and punctuality.
• Identifies patients directly or via referral for direct care by implementing a screening process and incorporating interview methods to verify resources.
• Serve as a liaison between clinics and different healthcare benefits by improving communication and education to our patients.
• Assists individuals and families with alternate resource applications, to include but not be limited to AHCCCS; KidsCare; Medicare; Medicare Cost Sharing Program; Medicare Prescription Plan; Freedom to Work; Long-term care; Social Security Benefits; Arizona Breast & Cervical Cancer Treatment; Pregnant Women; Veterans Health Benefits; Marketplace; and other potential payers.
• Establishes and verifies eligibility for Alternate Resources for the patients.
• Performs outreach to the community regarding enrollment activities and educate community members at health fairs, chapter houses, school, local events, fairs, etc.
• Contact potential eligible patient at home, local hospital, and/or rehabilitation facility to complete alternate resource application/screening. 
• Visits with patients to finalize documents necessary for assistance approval. Obtains legally relevant medical evidence, physician statements and all other documentation required for eligibility determination.
• Submits patient's applications accurately online (Health E Plus interfaced with the Marketplace) and to the separate governmental agencies, follows application status to completion and updates account with verified third party information.
• Follows up on all pending applications and works closely with families and agencies to see that the patient is not discriminated against as they are Indian Health Service (IHS) recipients.
• As a Certified Application Counselor; employee is certified to assist consumers in understanding new programs; taking advantage of consumer protections, and navigating the health insurance system to find the most affordable coverage that meets the consumer’s needs.
• Utilizes professional communication techniques in working with other departments and outside agencies.
• Performs continuous research and updating of information involving changes in rules and regulations for Alternate Resources, which includes attending Health and Human Services (HHS) training and webinars.
• Works closely with Patient Access staff, Purchase Referred Care, Social Services, and Revenue Cycle for updates, corrections, and changes of status with each alternate resource plan.
• Follows up with benefits coordinators at other agencies to ensure enrollment takes place on hospitalized patients.
• Set up monthly office hours at the local chapters in the community to assist patient follow up on their application.
• Assist patient with Medicare and Private Insurance Coordination of Benefits and/or any billing discrepancies that may delay care.
• Attends managed care meetings and other meetings related to Patient Benefits. Provides written and verbal weekly reports for referred care patients to the committee.
• Tracks on a written format direct and referred care activity and workload on a daily basis.
• Follows all guidelines of Privacy Act and HIPAA.
• Requires completion of tasks or duties assigned by a supervisor.
• Upholds all principles of confidentiality and patient care to the fullest extent.
• Adheres to all professional and ethical behavior standards of the healthcare industry.
• Adheres to WIHCCs Personnel Policies and Procedures, departmental policies, rules, and regulations.
• Interacts in an honest, trustworthy and dependable manner with patients, employees, visitors, and vendors.
• Possesses cultural awareness and sensitivity.
• Maintains compliance with all Human Resources requirements.
• Performs other duties as assigned.

Qualifications

Minimum Qualifications:

High School or GED. Four years of experience working with a variety of alternate resources including but not limited to, Medicare, Medicaid, AHCCCS, PPO’s, HMO’s, DDD, LTC and various others. Bilingual skills in English and Navajo language preferred. Must maintain a valid unrestricted and insurable driver’s license. Must successfully pass a background investigation and maintain suitable requirements for a Child Care position. This position is considered as a Child Care position, which requires a satisfactory background check investigation and is subject to the requirements of the Indian Child Protection and Family Violence Prevention Act, as amended (henceforth referred as the ICPFVP Act).

Knowledge, Skills, Ability:

•  Knowledge of alternate resource applications such as AHCCCS, Medicare, Long-Term Care, Marketplace, SSI and other potential payers.
• Knowledge of the Privacy Act of 1974, Health Insurance Portability and Accountability Act (HIPAA) of 1996, HITECH Act of 2009 and the WIHCC Policy and Procedures and the use of confidential information and health records as an integral part of the interviewing office functions and the privacy of individuals, which must be protected to the fullest extent possible.
• Knowledge of Resource Patient Management System (RPMS) packages such as RCIS, PTRG, PCC, EHR and the scheduling package.
• Knowledge of the Health-e-Arizona Plus online application system.
• Knowledge of the AHCCCS online to verify eligibility.
• Knowledge of the Centers for Medicare & Medicaid Services Enterprise Portal to complete yearly certification for Certified Application Counselors.
• Knowledge of strong work ethics in the workplace.
• Knowledge of the Affordable Care Act.  Knowledge of basic application of confidentiality.
• Knowledge of basic computer skills, e.g. Outlook, Word, Excel, PowerPoint.
• Ability to coordinate services between all other agencies and departments.
• Ability to be dependable in attendance and job performance.
• Ability to meet attendance, overtime (if necessary), and other reliability requirements of the job.
• Ability to accept and learn from feedback.
• Ability to communicate effectively both verbally and in writing.
• Ability to provide exemplary customer service at all times.
• Ability to interact positively with others and possess great interpersonal skills.
• Ability to multitask and perform well under pressure.
• Ability to have self-confidence.
• Ability to be a great team player.
• Ability to accept and learn from supervisor/peer critique.
• Ability to be flexible and adaptable to the changing needs of the organization.

Physical Demands:

While performing the duties of this job, the employee regularly is required to walk; sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee frequently is required to stand; climb or balance; and stoop, kneel, crouch, or crawl. The employee frequently is required to taste or smell. The employee must occasionally lift and/or move up to 25 pounds.   Travel in GSA vehicle to reach patient homes and location.  May transport patient to appropriate department/office to apply for benefits.

Work Environment:

Work is performed in an office setting or outdoor work environment with a moderate noise level. Work environment may involve exposure to physical risks, such as blood borne pathogens and operating dangerous equipment or working with chemicals. Evening and/or weekend work may be required. Extended hours and irregular shifts may be required.

As required by P.L. 93-638, absolute preference will be given to qualified Navajo applicants.  If there is no qualified Navajo applicant, preference will be given to qualified American Indian applicants.