Patient Benefits Coordinator

POSITION SUMMARY

Serve as an advocate for patients in effective utilization and application of alternate resources such as Medicare, Medicaid, Department of Veterans Affairs (DVA) and Private Insurance Billing (PIB, Children’s Special Health Services). Ensure that all patients who are eligible for alternate resources are identified, contacted and encouraged to apply for and maintain eligibility for available benefits, while maintaining a high level of professional customer service. Assist with patient registration, collecting and entering patient demographics, and updating and collecting required patient forms. Maintain privacy and confidentiality of information as required by HIPAA. Ensure that all policies and procedures are followed. Perform administrative duties including scheduling appointments, maintaining electronic medical records, billing, and coding information for insurance purposes.

ESSENTIAL FUNCTIONS

1. Greet patients, staff, and visitors in a positive, helpful, and professional manner.
2. Interview patients to obtain accurate demographic information to determine eligibility for alternate medical insurance resources such as Medicaid, Medicare, Veteran’s Health Insurance, Health Insurance Marketplace, Private Employer Health Insurance and other medical insurance programs.
3. Assist patients and their families with processing official applications for insurance benefits. Transmit all applications for alternate resources to the appropriate agency; track and monitor the processing of applications.
4. Update electronic health records and/or inform patient registration and other appropriate staff when new or updated benefits applications are approved. Follow-up on approval of new or adjusted benefits with patient.
5. Educate patients on insurance coverage(s) and how to utilize the services/benefits. Provide interpretation of rules and regulations from the organization providing the benefit, as well as the rules governing Tribal/IHS services.
6. Develop a follow-up system to track all applications for alternate resources and to monitor renewal/end dates. Follow up to ensure deadlines are not missed.
7. Participate in Utilization Review by attending PRC Review and other committee meetings.
8. Document all work activities on finding/maintaining alternate resources on the “notes page” of the patient’s chart in the health record system.
9. Continually research alternate resources, exploring all available options for patient coverage. Share information obtained with other staff members.
10. Develop and maintain a network of contacts in local, state and federal agencies to better assist patients in obtaining other resources, including all agencies and organizations that provide alternate resources for healthcare.
11. Compile statistics and prepare monthly and annual reports.
12. Provide backup in all areas of Patient Registration such as maintaining current and accurate patient data, screening new and existing patients, answering phones, collecting co-payments, generating receipts, audit and balance of financial transactions ensuring accurate daily deposits and completion of all required forms for patients.
13. Maintain confidentiality of patient and financial files.

MINIMUM QUALIFICATIONS

Six (6) months of directly applicable experience in insurance or medical field.

High School Diploma or GED.

KNOWLEDGE, SKILLS AND ABILITIES

To perform this job successfully, an individual must be able to perform each responsibility satisfactorily. These requirements are representative, but not all-inclusive, of the knowledge, skill, and ability required for this position.

1. A working knowledge of Medicare/Medicaid government insurance programs, Veterans Administration services and the Health Insurance Marketplace.
2. Knowledge of the eligibility requirements for Medicare/Medicaid or other insurance programs.
3. Knowledge of Revenue Cycle Management (RCM).
4. Administrative and recordkeeping principles and practices and medical terminology.
5. Principles and practices of medical records laws, codes and regulations.
6. Correct business English, including spelling, grammar and punctuation.
7. Techniques for dealing with a variety of individuals from various socioeconomic, ethnic and cultural backgrounds, in person and over the telephone.
8. Principles of customer service and support work.
9. Reading and explaining rules, policies and procedures.
10. Sorting materials in alphabetical, numerical or chronological order without errors.
11. Compiling and summarizing information and preparing periodic or special reports.
12. Contributing effectively to the accomplishment of team or work unit goals, objectives and activities.
13. Establishing and maintaining effective working relationships.
14. Knowledge of RPMS/electronic data entry systems and computer operations. Entering data into a specified computer format.
15. Knowledge of and understanding of HIPAA and the Privacy Act.
16. Ability to function independently at times and the ability to be self-directed.
17. Excellent interpersonal, verbal and written communication skills.
18. Knowledge of Microsoft Office Suite; Windows Explorer (electronic file-handling), Microsoft Word; Microsoft Excel; design software; internet software; and electronic database health records systems.
19. Basic operation of a workstation (turning on/off, knowledge of basic functions and components). Use/storage/maintenance of multiple usernames and passwords.
20. Computer-related problem-solving skills through the use of available training and help desk.
21. Demonstrated listening skills and giving full attention to what people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.