Patient Benefits Coordinator - Echo Cliffs

Tuba City Regional Health Care Corporation; Kugluktuk; On-site; CAD 72,000 - 94,000; Full time

Job summary

Tuba City Regional Health Care Corporation seeks a dedicated Alternate Resources Specialist to help patients access programs like Medicare, Medicaid, AHCCCS, and the Marketplace. You will verify eligibility, guide applicants through the Health E Plus system, and coordinate with federal and tribal agencies to ensure timely approvals.

The role requires CAC certification within two weeks, completion of mandatory training, and strong communication skills to assist diverse patients and families under

Qualifications

• High school graduate or GED.
• Must become Certified Application Counsellor (CAC) within 2 weeks from date of hire.
• Must complete up to 30 hours of an HHS-developed training program and pass an exam within 2 weeks from date of hire.
• One year of experience working with alternate resources in a healthcare setting (AHCCCS/ALTCS, Medicare, State Programs, Social Security/disability and Marketplace).

Responsibilities

• Assist patients in applying for and using Alternate Resources (Medicare, Medicaid, AHCCCS, VA, Marketplace).
• Establish and verify eligibility for Alternate Resources with relevant agencies.
• Provide information on rights and benefits of resources and assist with denials.
• Visit patients to finalize documents for assistance approval and submit online.

Skills

Communication

Ethical standards

Flexibility

Computer literacy

Interpersonal skills

Education

High school diploma or GED

Tools

Health E Plus

Marketplace

Job description

Navajo Preference Employment Act

In accordance with Navajo Nation and federal law, TCRHCC has implemented an Aff… Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference.

Overview

Position Summary

The primary purpose of this position is to identify patients who are eligible for Alternative Resources and serves as a liaison between the patient, hospital, and governmental agencies. This position requires the ability to work under conditions of frequent interruptions, be autonomous, collaborative and willingness to work a flexible schedule. Ensures applicable federal, state, local and organizational privacy laws and regulations are followed with issues related to Health information, confidentiality, release of information and patient rights. Assist uninsured individuals in determining their eligibility; facilitate the selection of and apply for a Qualified Health Plan or other public benefit programs; also provides education services, assist with PRC referrals from Case Management at Echo Cliffs Clinic.

Qualifications

Necessary Qualifications

Education

High school graduate or GED

Certification/Licensure

• Must become Certified Application Counsellor (CAC) within 2 weeks from date of hire
• Must complete up to 30 hours of an HHS-developed training program and pass an exam within 2 weeks from date of hire

Experience

One (1) year of experience working with alternative resources in a healthcare setting (AHCCCS/ALTCS, Medicare, State Programs, Social Security/disability and Marketplace.

Other Essential Skills and Abilities

A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas:

• Positive working relationships with others
• Possession of high ethical standards and no history of complaints
• Reliable and dependable; reports to work as scheduled without excessive absences
• Ability to work under conditions of frequent interruptions and availability to work flexible schedule
• Possesses and employs an ability to communicate with patients and families during time of emotional and physical stress
• Good oral and written skills and computer literacy for online enrolment assistance
• Completion of and above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job
• Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job
• Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job
• Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading, or incomplete information, as determined by TCRHCC.

Mental and Physical Effort

The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Physical

The work is primarily sedentary with the following physical requirements: Ability to lift up to 25 lbs, walk/stand for short periods of time as interaction between all disciplines within the facility is required, ability to stoop and pick up objects from the floor without restrictions.

Mental

Must be able to prioritize and use good judgment and have the critical thinking skills to problem solve and plan, identify and question issues and information in order to make appropriate assumptions, inferences, implications, and decisions. Must be able to effectively communicate with staff, providers, senior leaders, legal counsel, and external entities.

Environmental

While in this position you may continuously be exposed to infectious diseases and occasionally to extremes in temperature or humidity and loud noises.

Responsibilities

Essential Functions

1. Assist patients in application for and use of Alternate Resources; works closely with Patient Financial Services and other staff in identifying all Alternate Resources available. Resources are Medicare, Medicaid, Arizona Health Care Cost Containment System (AHCCCS), Department of Veterans Affairs, Bureau of Employment Compensation, Third Party Liability, Workers’ Compensation, Children’s Special Health Services, Aide to Families with Dependent Children and assist with affordable health insurance required by Federal and State requirements, relevant to the Affordable Health Care Act of 2013/Tribal Exemption.
2. Establishes and verifies eligibility for Alternate Resources for the patients; must work closely with the Social Security Administration Offices (local and regional), VA, Tribal Offices, Community Department of Welfare or Human Resources, Department of Social Services, State Medical Assistance Office and other appropriate agencies.
3. Provide information on rights and benefits of resources; advise patients of non-payment or denial of claims. If denials or other rejections occur, incumbent will intervene on patient’s behalf in disputing and debating the denial by third party sources.
4. Visits with patients (Outpt) to finalize documents necessary for assistance approval. Obtains legally relevant medical evidence, physician statements and all other documentation required for eligibility determination. Submits patient's applications accurately online (Health E Plus interfaced with the Marketplace) and to the separate governmental agencies, follows application status to completion and updates account with verified third party information.Follows up on all pending applications and works closely with families and agencies to see that the patient is not discriminated against as they are Indian Health Service (IHS) recipients.
5. Performs a variety of patient representative functions including completion of applications for Alternate Resources (Medicaid, Marketplace, VA, and Disability), verify eligibility with Social Security Administration Offices, and interpret rules and regulations for Alternate Resources for patients.
6. Perform continuous research and updating of information involving changes in rules and regulations for Alternate Resources, which includes attending Health and Human Services (HHS) training and webinars. Will attain knowledge of total program operations, the priorities and goals of the Alternate Resources program. Will keep abreast of current changes in policies, regulations on Alternate Resources eligibility, medical terminology, financial coding and CAC daily reporting.
7. Directs educational meetings with groups from 5 – 25 participants by planning, delivering instructional materials and speaking.
8. Refers consumers seeking assistance to other Marketplace resources (i.e. referring to toll-free Marketplace Call Center or to another CAC can better serve the consumer). This also includes assisting patients/consumers who reside out of state by referring them to appropriate contacts in the patient/consumer’s State.
9. Provides information and application assistance in a fair, accurate, and impartial manner. Such information must acknowledge other health programs such as Medicaid and Children's Health Insurance Program (CHIP); facilitates consumer selection of a Qualified Health Plan/Exemption.
10. Provides referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under Section 2793 of the PHS Act, or any other appropriate State agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage.
11. Provides information in a manner that is culturally and linguistically appropriate to the needs of the population being served; meets Culturally & Linguistically Appropriate Services (CLAS) standards.
12. Requires interpretation of third-party billing/coverage requirements for patients, community events and providers.
13. Performs other duties as assigned including transportation arrangement for patients, PRC referrals from Case Management assist with needed resources and proper paperwork.