Third Party Coordinator

Kickapoo Traditional Tribe of Texas; Eagle Pass, Northern (TX, KY); Hybrid; USD 42,000 - 56,000; Full time

Job summary

Kickapoo Community Health Center in Eagle Pass, Texas is seeking a Third Party Coordinator to assist tribal members with health insurance applications and program eligibility.

You will educate patients on Medicaid, Medicare, private and marketplace options, coordinate with PRC and clinic staff, process applications, ensure accurate data, and help patients navigate benefits while maintaining HIPAA compliance.

Qualifications

• Must have knowledge of Medicare, Medicaid and private insurance policies and requirements for coverage of all levels of care.
• Fluent in English and Spanish; strong communication skills in both languages.

Responsibilities

• Assist patients/tribal members with insurance applications and eligibility for state and federal programs.
• Educate patients on Medicaid, Medicare, Private, Marketplace, VA Benefits, etc.
• Coordinate with PRC and clinic staff to maximize third-party coverage and minimize patient out-of-pocket costs.
• Verify information, follow up on applications, and maintain timely communications with government agencies.
• Provide coverage and scheduling assistance as needed; maintain confidentiality and HIPAA compliance.

Skills

Medicare/Medicaid knowledge

Bilingual English/Spanish

Communication

HIPAA compliance

Customer service

Team player

Independent judgment

Education

High school diploma or equivalent

Associate or Bachelor’s in health/science

Job description

Position: Third Party Coordinator

Supervisor: Business Office Manager

Division: Health Services Administration

Department: Kickapoo Community Health Center

Responsibilities:

Assists patients/tribal members with the overall process of health care insurance application process and eligibility inquires. Assists patients in applying for benefits offered by state and federal programs for which they are eligible. Meet one-on-one with patients, helping them navigate the processes of insurances for healthcare purposes. Gather information from patients to assist with the application processes ensuring all patient information is accurate and up to date. Works closely with Clinic Business Office and PRC staff members to ensure patient has exhausted all possible alternative methods of third-party payers’ eligibility for medical, medication, and dental insurance coverage.

Essential Duties and responsibilities include the following:

• Screen and educate patients about different insurances and benefits, Medicaid, Medicare, Private, Marketplace, VA Benefits, etc.
• The third-party coordinator will assist families with third-party coverage eligibility process for health insurance coverage by completion of applications for state and federal programs which include those listed above to also include food stamp and prescription drug assistance programs. This is not an all-inclusive listing.
• Monitors and fosters ongoing communications with government agencies regarding the status of applications.
• Effectively educates and answers inquiries from patients and family representatives regarding application process.
• Assists patients in resolving account issues by identifying and taking appropriate actions including completing required forms to support application process.
• Reviews email for daily work queues, identifying missing evidence and follows through to completion.
• Assists patients with scheduling appointments and reminding of appointments as needed.
• Works as a team member with other departments to assist in the completion of the insurance application process.
• Works with the PRC team to identify patients who might benefit from alternate resource options.
• Completes administrative duties, monthly reports, special assignments and work activities in a professional and timely manner.
• Works under minimum supervision with considerable latitude for the use of initiative and independent judgment.
• Maintains confidentiality and adheres to mandated HIPAA regulations.
• Conducts home visits, when necessary, to assist with the insurance application process.
• Assists patients/clients in obtaining financial assistance, or health care assistance through local, state, federal and/or Native American programs (i.e. faxing required documents such as a proof of income)
• Utilizes Clinic software programs to do entry, NextGen, word processing, spreadsheets, electronic mail and Internet.
• Attends trainings, webinars, relevant to job to meet certification requirements.
• Maintains professional knowledge and proficiency through continuing education, in-services and workshops relating to the job position.
• Participates in other assigned duties as designated by the Supervisor to include, but not limited to participation on designated committees.
• Assists patients with mail, making calls to Medicaid, Medicare and other entities relating to eligibility Assists patients with making phone calls to Medicaid, Medicare, other entities relating to eligibility for Provider Services.
• Assists patients with calling Medicaid to assign their Primary Care Provider
• Employee participates in clinic performance improvement activities to measure, assess and improve the quality of care.
• Employee must maintain confidentiality, security and integrity of patient data and information according to privacy regulations, including HIPAA. Employee assures age and culturally appropriate, holistic patient care based on mission, standards and policies; adheres to standards of relevant regulatory agencies.
• Employee must consistently be courteous to patients, staff and visitors.
• Coordinates with Purchased Referred Care (PRC) Registrar with follow up for Third Party Eligibility for health insurance with PRC files.
• Assist Tribal Members and other Native Americans with incentive applications as offered by KTTT
• Maintains all project, client, patient files, in an organized, safe and confidential manner at all times
• Provides coverage as need to Business office staff with in person and phone call requests for patient appointments, questions, and registration assistance.
• Assist with providing coverage for clinic medical records requests
• Performs insurance eligibility verifications days before Clinic appointments and notifies patients of any discrepancies or copays that may be due at the time of appointments.
• Assists tribal member community with notarization requests
• Routinely retrieves clinic mail from administration building
• Other duties as assigned by supervisor.

Knowledge, skills and abilities for the position:

• Must have a working knowledge of Medicare, Medicaid and private insurance policies and requirements for coverage of all levels of care. Must have the ability to work effectively with others.
• Ability to communicate orally, understand and interact 100% of work time with physician, ancillary staff, patients and their families, and community agencies.
• The employee must be able to communicate effectively in person or using telecommunications equipment.
• Computer literate/knowledge, ability to use office machines, printers, PC, copier and calculator.
• Required to use computer and medical equipment.
• Mathematics: Ability to perform simple arithmetic for time-keeping and counting calculations.
• Language & Communication: Ability to read, write, speak and understand English and Spanish, and communicate effectively with others.
• Ability to understand, provide and follow written and verbal direction.
• Attention to detail and accuracy.
• Ability to manage and maintain security of confidential data and information.
• Ability to exercise independent and sound judgment.
• Ability to empathize with patients in a variety of settings.
• Cultural awareness of and sensitivity to Kickapoo traditions, religious beliefs and way of life
• Must have good customer service skills and be a team player.
• Employee must demonstrate ability to solve problems and deal with a variety of variables; ability to interpret and provide instructions furnished in written, verbal, diagram or schedule form.

Supervision exercised:

This position does not carry out supervisory responsibilities in accordance with the organization’s policies and applicable laws.

Education/experience requirements:

Minimum Qualifications: Graduation from high school or equivalent.

One-year full-time administrative support, general office, clerical, secretarial experience.

Preferred Qualifications: Associate degree or bachelor’sdegree in a science or health related field from an accredited college or university and previous work-related experience is preferred.

Native American preference is observed:

KTTT recognizes preference for KTTT tribal members and qualified Native American tribal members including preferential treatment in recruitment, hiring, promotions, layoffs and reductions in force so long as they meet minimum job qualifications.