Patient Benefits Coordinator - Temporary

Job Details: Education Level: High School, Salary Range: Undisclosed, ESSENTIAL DUTIES, FUNCTIONS AND RESPONSIBILITIES Identifies and qualifies patients for healthcare benefits and alternate resources. Works as a liaison between the community and Medicare, Medicaid, Veterans Administration, New Mexico Health Insurance Exchange providers, medical services, private insurances, SSI, SSDI, State programs and other applicable resources.

Develops effective screening and interviewing methods to assure maximum identification of individuals who may be eligible for alternate resources. Conducts personal interviews with patients and/or family members to gather and research personal and sensitive patient information. Compiles information to determine benefits.

This may include making home visits to follow up on incomplete applications. Serves as a patient advocate and in partnership with community members in obtaining alternate resources and healthcare benefits. Provides community outreach and education on alternate resources to patients. Monitors eligibility of benefits for qualified patients to minimize breaks in coverage.

Assists healthcare and other professional staff members in understanding elements and requirements of Social Security Administration/Disability Determination on Services and how to best help individuals with disabilities to obtain benefits. Updates Patient Benefits information and 3rd party benefits information. Tracks assistance applications; compiles and distributes information regarding patient personal insurance and financial status; provides appropriate forms to billing and other departments.

Collaborates with other departments such as Patient Registration, Medical Records, Billing, and Purchase Referred Care to update patient application and information. Obtains documentation from patients to establish eligibility for services. Maintains sufficient records, authorizations or clinic information, eligibility forms and standard forms and explain patient’s rights under the Privacy Act and HIPAA guidelines.

Works with Purchase Referred Care in determining patient eligibility for care under the PRC. Researches and identifies alternate resources available to patients, while ensuring superior, quality care of the patient(s). Provides support to Patient Registration, Medical Records and Purchase Referred Care personnel. Enhances professional growth and development through participation in educational programs, meetings, and workshops as assigned or appropriate.

Compiles and provides written monthly reports. Follows departmental policies, procedures, and objectives, continuous quality improvement objectives, and safety, environmental, and/or infection control standards. Provides information to patients and community on current changes and updates of all resources and guidelines for eligibility of patients.

Completes required certification training (Presumptive Eligibility Determiner) to gain access to assist patients with Medicaid eligibility. Performs other duties as assigned. : Experience Two (2) years of similar or related experience in a healthcare setting.

Education

High School Diploma Mandatory Knowledge, Skills, Abilities and Other Qualifications Must be able to carry out the essential duties, functions and responsibilities. Knowledge of applicable federal, state, county and local laws, regulations and requirements. Knowledge of medical insurance claims procedures and documentation.

Knowledge of the precertification requirements, procedures and documentation of third-party medical insurance payors. Ability to gather data, compile information, and prepare and maintain written records and reports. Strong working knowledge of computers and software applications. Knowledge of Medicaid, Medicare, Social Security, Tribal, and Department of Human Services and private health insurance.

Knowledge of a body of standardized rules, procedures, or operation that require considerable training and experience to perform the full range for a Patient Benefits Coordinator and resolve recurring problems. Excellent knowledge of a healthcare setting. A team player with excellent communication and interpersonal skills.

Ability to communicate clearly and effectively with patients and other external parties in a courteous and friendly manner at all times. Must be able to maintain confidentiality at all times. Ability to perform other duties as assigned.

PREFERRED QUALIFICATIONS

Bilingual skills in English and the Navajo language. Bachelor’s degree in Business Administration. Three to five years of clinical setting or equivalent experience as a Patients Benefits Coordinator.