Patient Benefits Coordinator

SUMMARY: The primary purpose of this position is to identify patients who are eligible for alternate resources, assist them with the enrollment process, and advocate for Indian patients in the effective utilization of available alternate resources. The Patient Benefits Coordinator works with patients, families, Tribal programs, and outside agencies to establish eligibility, obtain benefits, and ensure patients have access to available healthcare resources.

ESSENTIAL DUTIES and/or RESPONSIBILITIES include the following:

• The Patient Benefits Coordinator provides leadership and advocates for Indian patients in the effective utilization of alternate resources, including Medicare, Medicaid, Veterans Administration benefits, third-party liability, Children's Health Insurance Program (CHIP), Temporary Assistance for Needy Families (TANF), and other applicable programs.
• Works with Patient Registration Clerks to screen patients for potential eligibility for alternate resources as appointments are scheduled.
• Identifies patients who have, or may be eligible for, alternate resources by effectively implementing screening, interviewing, and eligibility verification procedures.
• Works closely with CTCHEC staff to identify and coordinate the utilization of alternate resources available to the Indian population.
• Meets with Purchased/Referred Care (PRC) staff weekly to identify patients who may be eligible for additional third-party resources and coordinate follow-up to assist with eligibility determination and enrollment.
• Assists individuals and families with applications, enrollment, and effective use of available alternate resources.
• Establishes eligibility for potential Medicare recipients by coordinating with the Social Security Administration at the local and national levels.
• Works with local Department of Health and Human Services offices, Tribal offices, and other appropriate agencies to establish eligibility for Medicare, Medicaid, including pregnancy-related coverage, WIC, TANF, Supplemental Security Income, and other applicable programs.
• Verifies eligibility by contacting the appropriate Social Security Administration office, Department of Social Services (DSS), State Medical Assistance Office, or other responsible agency.
• Interviews patients eligible for Medicare and Medicaid to ensure they understand their benefits and entitlements when receiving services through Tribal 638 and Indian Health Service facilities.
• Collaborates with Social Services and other departments to identify potentially eligible patients, including elderly patients whose health status or circumstances may indicate eligibility for alternate resources.
• Assist patients with applications for alternate resources and guides program requirements, eligibility rules, and enrollment procedures.
• Updates and maintains accurate patient demographic information in the Electronic Health Record (EHR) and Resource and Patient Management System (RPMS), ensuring patient records are current and complete.
• Follows up on pending eligibility determinations and applications, working with patients, families, and outside agencies to resolve outstanding issues and help ensure Indian patients are treated fairly in their access to available benefits.
• Performs patient advocacy and representative functions, including:
  • Assisting patients with applications for alternate resources.
  • Conducting home or hospital visits, as appropriate, to interview patients and assist with eligibility and enrollment needs.
  • Providing transportation assistance to Department of Health and Human Services, Social Security, Supplemental Security Income, or other appropriate offices when necessary and authorized.
  • Explaining alternate resource program requirements, rules, and regulations to patients and families.
  • Researching and maintaining current information regarding changes in alternate resource programs, eligibility requirements, policies, and regulations.
  • Assisting pregnant patients with Medicaid presumptive eligibility and private insurance eligibility, as applicable.
  • Providing advocacy and benefits assistance to patients utilizing the Omaha Tribal Dialysis Unit.
• Serves as backup for Patient Registration and performs related duties as needed.
• Maintains patient confidentiality and complies with applicable privacy requirements, organizational policies, and procedures.
• Documents all patient encounters in the Resource and Patient Management System (RPMS) page 5, ensuring documentation is accurate, complete, and maintained in accordance with established procedures.
• Performs other related duties as assigned.

• Other duties as assigned.

QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the duties.

EDUCATION and/or EXPERIENCE:

• High school diploma or GED
• Associate degree in Business or a related field, or a equivalent of two (2) years of experience working in an office setting, preferably in a healthcare environment.

CERTIFICATES, LICENSES, and/or REGISTRATIONS:

• Valid state driver's license and ability to maintain insurable.

KNOWLEDGE, SKILLS, and/or ABILITIES:

• Knowledge of the operations, priorities, and objectives of alternate resource programs.
• Ability to remain current with changes in eligibility requirements, regulations, and policies governing alternate resources.
• Working knowledge of third-party resources, including Medicare, Medicaid, the Social Security Administration, county Department of Health and Human Services offices, Tribal programs, and other related agencies, including their procedures, required forms, and eligibility requirements.
• Practical knowledge of medical terminology and a general understanding of ICD-10-CM and CPT coding systems.
• Knowledge of applicable alternate resource regulations, including P.L. 94-437, Title IV of the Indian Health Care Improvement Act, Indian Health Service policies and regulations on alternate resources, 42 CFR 36.21(a) and 36.23(f), and P.L. 99-272, the Federal Medical Care Cost Recovery Act, as applicable to the position.
• Ability to communicate effectively with patients, families, healthcare personnel, Tribal programs, government agencies, and other outside organizations.
• Ability to maintain accurate records, protect confidential information, and follow established policies and procedures.
• Ability to organize work, follow up on pending eligibility matters, and assist patients with complex enrollment and benefits questions.
• Ability to use electronic health records and patient management systems to update and maintain accurate patient information.

PLEASE NOTE: P.L. 93-638, Indian Preference and Tribal Employment rights Ordinance. (T.E.R.O) will be practiced; however, all qualified applicants will be considered.

IF YOU ARE INTERESTED, PLEASE SEND APPLICATIONS RESUME TO:

OMAHA TRIBE OF NEBRASKA

ATTN: HR DEPARTMENT

P.O. BOX 368

MACY, NEBRASKA 68039

OR

EMAIL: othumanresources@theomahatribe.com