Contact Representative (Benefits)

Job Duties

There MAY NOT be immediate vacancies at all locations.

Verifies and determines patient's eligibility for Medicare, Medicaid, Private Insurance, VA or other potential alternate resources.

Provides information on rights and benefits of multiple alternate resources and advises patient of nonpayment or denial of claims.

Identifies and follows up on pending applications and timely entry of all third party resources.

Conducts face-to-face interviews or by telephone with patients and/or families to ensure accurate and complete enrollment application.

Obtains copies of verification of household income or other source of documentation, requests all other income from beneficiary and household members.

Initiates medical authorizations and denial of service for inpatient/outpatient/ancillary medical services for eligible IHS beneficiaries. Investigates and analyzes controversial issues.

Issues correspondence to patients, health care providers and other agencies regarding eligibility, IHS policy and regulations, including letters of denial of payment where the requirements of the IHS Program are not met.

Tracks all referrals to non-IHS facilities to include those referrals to other IHS facilities to support the Case Management activities and continuity of care efforts. Participates in the weekly Case Management meetings, takes minutes and prepares the minutes for record and reporting purpose.