Patient Benefits Coordinator

OHC Patient Benefits · RAPID CITY, South Dakota
Department OHC Patient Benefits
Employment Type Full-Time
Minimum Experience Entry-level

GPTLHB IS A MANDATORY VACCINATION ORGANIZATION THE EMPLOYEE IS RESPONSIBLE FOR PROVIDING PROOF OF INOCULATIONS BEFORE EMPLOYMENT





Job Summary:

This position is responsible for advocating for patients in the effective utilization of alternate resources and ensure that all patients who are eligible for alternate resources are identified, contacted and encouraged to apply for and maintain eligibility for available benefits.

 

Essential Functions:

  • Determine 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 position 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.
  • Organize community enrollment events and actively participate in other community programs events. 


Professional Behavior  

  • Effectively plan, organize workload and schedule time to meet the demands of the position.
  • Work in a cooperative and professional manner with OHC and GPTCHB staff.
  • Treat Great Plains tribes and collaborators with dignity and respect.
  • Utilize effective verbal and written communication skills.
  • Advance personal educational development by attending training sessions and seminars as appropriate.
  • Exemplify excellent customer service with tribal stakeholders, health board colleagues, program partners, service recipients, visitors and guests.
  • Foster a work environment of wellness, courtesy, friendliness, helpfulness and respect.
  • Relate well and work collaboratively with coworkers and all levels of staff in a professional manner.
  • Consistently demonstrate respect for and acceptance of differing capabilities, cultures, gender, age, sexual orientation and/or personalities. 
  • Maintain and ensure organizational privacy and confidentiality.
  • Handle crisis and tolerate stress professionally.
  • Be self-directed and take proactive initiative to assist others.
  • Resolve issues with other departments and coworkers without direct supervision as needed. 
  • Exercise flexibility to alter plans/routines when situations require and continue to perform without projecting stress/frustration that would adversely affect the work environment.
  • Promote an alcohol, tobacco and drug-free lifestyle.
  • Embrace modes of appearance and attire that reflect a professional presence.
  • Adhere to GPTCHB policies and procedures.


Requirements

  • Knowledge of and ability to apply alternate resources regulations.
  • Knowledge of various third-party payers, applications processes, and eligibility requirements.
  • Knowledge of computers and job-related software programs and office equipment.
  • Knowledge of customer service principles.
  • Ability to work with personal computer and utilize a variety of software applications.
  • Ability to communicate clearly and effectively, both orally and in writing.
  • Ability to effectively meet and communicate with the public.
  • Ability to organize the multiple demands of the job.
  • Ability to drive a motor vehicle in adverse weather conditions.
  • Skill in providing exceptional customer service.
  • Skill in prioritizing and planning.
  • Skill in interpersonal relations.
  • Skill in the maintenance of files and records.
  • Skill in the use of such office equipment as a computer, scanner, fax machine, and copier.
  • Skill in oral and written communication.

 

Guidelines

Guidelines include regulations from federal, state and local alternate resource agencies; Department of Human Resources Services regulations; GPTCHB, OHC, and department policies and procedures. These guidelines are generally clear and specific, but may require some interpretation in application.

 

Complexity/Scope of Work

The work consists of related administrative duties.  Travel to various locations throughout the local area contribute to the complexity of the position.

 

The purpose of this position is to determine patient eligibility for third party resources.  Successful performance contributes to the efficiency and effectiveness of business office operations.

 

Contacts

Contacts are typically with patients, other employees, local and state agencies, third party payer representatives, and the general public.  Contacts are typically to give and exchange information, resolve problems, and provide assistance.

 

Work Environment/Physical Demands

The work is typically performed while sitting at a desk or table or while intermittently sitting, standing or stooping. The work is typically performed in an office and the noise level in the work environment is usually quiet.  While performing the duties of this Job, the employee is regularly required to sit; use hands and fingers to manipulate, handle, or feel; and, talk or hear. The employee must regularly lift and /or move light objects.  Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

 

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Some local travel may be required.

 

Supervisory and Management Responsibility

None.

 

Minimum Qualifications

  1. High school diploma or equivalent.
  2. One (1) year of related experience to understand and perform the major duties of the position, and to be able to answer questions and resolve problems.
  3. Must successfully pass a criminal and background check, and a pre-employment drug screen.
  4. Current valid driver’s license.
  5. Must carry SD State minimum vehicle insurance.

Native American/American Indian Preference in hiring will be applied as defined in title 25 usc 44-46 &474.

Employment is contingent upon the outcome of all required criminal background checks and pre-employment drug screen.

Thank You

Your application was submitted successfully.

  • Location
    RAPID CITY, South Dakota
  • Department
    OHC Patient Benefits
  • Employment Type
    Full-Time
  • Minimum Experience
    Entry-level