Lead Patient Benefits Coordinator

Job Details: Job Location: Legal Address

• Ganado, AZ, Position Type: Full Time, Salary Range: Undisclosed, Travel Percentage: None, Position Summary: Under the direction of the Admissions & Patient Registration Supervisor, the Lead Patient Benefits Coordinator serves as a liaison between patients, Sage Memorial Hospital, and governmental agencies to ensure timely eligibility determinations and enrollment into alternate resources. The role requires autonomy, collaboration, flexibility, and the ability to work effectively under frequent interruptions while maintaining full compliance with federal, state, tribal, and organizational privacy regulations. The coordinator provides daily leadership and operational oversight for the Patient Benefits team and supports front-end revenue cycle functions.

Key responsibilities include

demographic and insurance data collection, patient registration, identifying and assisting patients eligible for alternate resources, facilitating enrollment, advocating for patients in accessing available programs, and addressing additional social service needs. The coordinator models high-quality, professional service and guides staff in meeting Sage Memorial Hospital standards.

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

Essential Duties

& Responsibilities:

• Provide day-to-day operational oversight of Patient Benefits workflow, offering peer guidance and support to staff; maintain current procedures, written processes, and training materials as directed by the supervisor.
• Guide orientation and training efforts for new and existing staff using supervisor-approved materials and departmental standards; report competency or accountability concerns to the supervisor for follow-up.
• Assign, balance, and monitor daily workload based on established priorities; track progress, identify barriers, and advise the supervisor of any needed adjustments; review work in progress for accuracy and compliance.
• Evaluate work quality and adherence to standards, returning items for correction when necessary and referring complex, disputed, or unresolved issues and backlogs to the supervisor for final resolution.
• Track staff performance, training needs, conduct, and behavior, and elevate any concerns to the supervisor. All formal performance management and corrective actions remain under the supervisor’s authority.
• Arrange short-term or emergency coverage and address routine staff questions or concerns; all leave approvals, employment decisions, and complex matters must be elevated to the supervisor.
• Support the supervisor in reviewing and drafting departmental policies and procedures; final approval and implementation authority rest with the supervisor and administration.
• Prepare proposed staffing schedules and coverage plans for supervisor review and approval; track completion of annual mandatory training and report exceptions.
• Participate in departmental meetings and facilitate in-service training and educational opportunities as assigned or approved by the supervisor.
• Support long and short-range planning for the hospital and incorporate the hospital’s mission into daily departmental activities.
• Interview patients in the hospital, in their homes, or by phone to determine eligibility for alternate resources; assist with applications, documentation, and online eligibility tools.
• Assist patients with eligibility for AHCCCS/Medicaid, Kids. Care, Medicare, VA Healthcare, Workers’ Compensation, Third Party Liability, Marketplace plans, Tribal programs, and other payors.
• Advocate for patients by appealing adverse eligibility determinations when appropriate and ensuring fair access to benefits.
• Conduct frequent follow-up with patients, families, and agencies to ensure compliance with program requirements and timely enrollment.
• Enter approved alternate resources into Meditech Expanse promptly to support timely billing and secure retroactive coverage when allowed.
• Ensure compliance with HIPAA, the Privacy Act, The Joint Commission standards, and all federal, state, tribal, and organizational regulations related to confidentiality, patient rights, and release of information.
• Maintain accurate records, tracking systems, reports, spreadsheets, and databases as required.
• Collaborate with Patient Registration, Utilization Review, PRC, Social Services, and Revenue Cycle to resolve coverage issues, prior authorization needs, billing discrepancies, and coordination of benefits.
• Assist patients with Medicaid, Medicare, and private insurance Coordination of Benefits to prevent delays in care.
• Serve as a liaison between clinics and various benefit programs to improve communication, education, and patient understanding.
• Support Purchased Referred Care referrals and assist with concurrent utilization review or discharge planning when requested.
• Estimate and report expected completion times for work assignments; maintain records of work accomplishments and time expended.
• Recommend and implement cost-containment strategies.
• Conduct community outreach and education at health fairs, chapter houses, schools, local events, and other community settings.
• Serve as a backup Admissions & Registration Clerk at management’s discretion.
• Perform additional duties, special projects, or assignments as needed.Qualifications: Minimum Qualifications:
• High School Diploma or General Education Diploma (GED).
• Two (2) to three (3) years of experience in either: a healthcare setting (hospital preferred), or the Arizona Department of Economic Security processing AHCCCS/Arizona Medicaid applications.
• Experience in patient benefits, patient registration, revenue cycle, or related healthcare functions.
• Leadership or supervisory experience preferred to support team oversight and departmental operations.
• Ability to speak the Navajo language and familiarity with the Navajo Way.
• Must successfully pass all Employee Health Program requirements and a background investigation. Knowledge, Abilities, Skills, and Certifications:
• Knowledge of Medicare, Medicaid/AHCCCS, Purchased Referred Care (PRC), Affordable Care Act (ACA), VA Healthcare, and other alternate resource programs.
• Ability to interpret federal, state, Tribal, and third-party payer regulations.
• Strong interviewing, communication, and customer service skills.
• Ability to work independently, manage multiple priorities, and maintain professionalism under frequent interruptions.
• Skilled in maintaining confidentiality and complying with HIPAA and Privacy Act requirements.
• Proficiency in computer systems, including Meditech Expanse, spreadsheets, and databases.
• Ability to collaborate effectively with internal departments and external agencies. Physical Demands: While performing the duties of this job the employee is required to sit for prolonged periods of time and may be required to run errands between other departments. The employee may occasionally need to lift and/or move up to 25 pounds weighted objects. Any necessary accommodation will be made to adhere to organizational, state, and federal guidelines where concerned. Work Environment: Work is performed primarily in an office setting with a moderate noise level and regular interaction with patients and staff. Occasional off-site work is required for outreach activities, home visits, and community events. The position may require extended hours, irregular shifts, travel, and flexibility in scheduling to meet departmental and patient needs.