The Patient Benefits Coordinator reviews patient benefit information and assists with the application process for various medical assistance programs to ensure accuracy of application and enrollment of the applicant.
ESSENTIAL FUNCTIONS (include, but not limited to the following)
- Interviews patients, families and other related parties to determine eligibility status for insurance coverage through various governmental sponsored programs
- Assists complete application, reviews and verifies information to ensure accuracy and completeness to facilitate processing
- Contacts appropriate agency to obtain current or updated information for patient enrollment accuracy and status changes
- Reviews client enrollment data; identifies errors and makes corrections as appropriate to ensure accuracy of data for timely reimbursement of charges
- Provides information and explanation of program benefits/coverage to patients and families
- Maintains approval and denial files current to provide ease of access for renewals and/or re-instatement
- Serves as primary contact to patients and patient’s families by providing basic information in response to inquiries and/or complaints regarding eligibility status
- Documents/logs all activities associated with interviews; provides weekly status report
- Provides explanations and/or guidance on insurance coverage and/or available community, local and/or regional resources
- Participates in departmental orientation, on the job training and quality assurance programs/initiatives
- Participates in a variety of department and hospital educational programs to maintain current skill and competency levels; identifies and discusses performance or training needs with Supervisor
MARGINAL/ADDITIONAL FUNCTIONS:
- May update patient database for insurance and/or other patient demographic data
- Performs other job related functions and activities as requested/required
- One year of specialized experience related to policies and regulations involved with making final eligibility determinations for income support programs, such as Medicare and Medicaid
High school diploma or GED equivalent
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Indian Preference and Equal Employment Opportunity
SCAHC gives preference in hiring to San Carlos Apache Tribal members and other Native Americans in accordance with the San Carlos Apache Tribe’s Tribal Preference Policy, as set forth in Section 402 of the Tribe’s Human Resources Department Policies and Procedures Manual. Otherwise SCAHC does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect him/her because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, citizenship, veteran status, military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, SCAHC complies with all applicable federal, and Tribal laws governing nondiscrimination in employment.
