Job Summary:
The TEMPORARY Eligibility Coordinator (EC) is responsible for verifying eligibility for services provided within Yellowhawk Tribal Health Center (Yellowhawk) by ensuring patients meet all Federal Regulations and/or policies for obtaining services. The Eligibility Coordinator is the first person that the patients have contact with at Yellowhawk Tribal Health Center. All duties and responsibilities will be performed in accordance with the Yellowhawk Mission and Vision statements.
Essential Job Functions:
1. Responsible for checking and obtaining all demographic patient information and ensuring all mandated fields within the system are complete and accurate with updated information.
2. Excellent customer service as will be working with the elder population, the sick, the hurt and the injured patients.
3. Responsible to make eligibility determination of Direct Care Only or Purchase/Referred Care.
4. Will be responsible to learn all aspects of Third Party carriers and understand insurance types and benefits such as Medical, Pharmacy, Dental, etc., and know/understand basic language and acronyms with regard to insurance. This includes proper use of group numbers, carrier names, types of carriers, etc.
5. Responsible for checking and verifying eligibility for any alternate resource for Medical, Dental, Behavioral Health and Pharmacy coverage.
6. Responsible to track any pending eligibility status and notify appropriate staff.
7. Responsible to work with patients and utilize on-line eligibility tools to verify insurance coverage for patients. (MMIS, Availity, etc.)
8. Must work as a team with all departments and keep up to date on rules and regulations with regard to all data entered into the RPMS/EHR.
9. Responsible to work with the Outstation Outreach Workers ensuring that all Yellowhawk patients have healthcare coverage.
10. Strict adherence to all HIPAA regulations.
11. Work towards cross-training with Referral Coordinator as coverage when needed.
12. Other duties as assigned.
Minimum Qualifications:
1. High school diploma or equivalent.
2. Must have good computer skills.
3. Is able to pick up new tasks/processes quickly.
4. Must possess exceptional communication skills.
5. Strict adherence with HIPAA due to direct patient contact.
6. Must be able to work well within a team atmosphere.
7. Must submit to and pass a reference and criminal background check and a pre-employment drug and alcohol screening.
Preferred Qualifications:
1. Knowledge and/or familiarity of Indian Health Services preferred.
2. Knowledge of Insurance types and terminology preferred.
Applicants will be required to submit a complete job application packet for each position they desire to apply for. A complete job application packet will include:
1. Completed employment application.
2. Cover letter – explaining your qualifications and experience relevant to the functions of this position.
3. Resume – identifying your qualifications and experiences relevant to the functions of this position.
4. High School Diploma/GED or copy of official college transcripts (if applicable).
5. Preference – appropriate documentation for either Tribal or Indian preference and/or Veteran’s preference.
