Patient Benefits Coordinator

Job Title

This position is responsible for advocating for patients in the effective utilization of alternate resources and ensure that all patients who are eligible for alternate resources are identified, contacted, and encouraged to apply for and maintain eligibility for available benefits.

Essential Functions

• Determine eligibility of patients and ensure appropriate identification of patients who have or are eligible for direct services.
• Determine eligibility of patients and ensure maximal identification of patients who have or are eligible for alternate third-party resources by effectively implementing screening and interview methods.
• Review Purchased Referred Care (PRC) referrals and verify patients' eligibility for services.
• Work closely with all facility staff in identification and proper utilization of all alternate resources available to all patients.
• Develop and maintain a network of contacts in local, state, tribal and federal agencies to better assist patients in developing other resources, including all agencies and organizations that provide alternate resources for health care.
• Follow up on all pending eligibility claims and work closely with families and agencies until completion of application.
• Work with patients to appeal denials from third resources as applicable.
• Works closely with medical staff to obtain pre-authorization for services.
• Document all encounters and work activities on finding/maintaining alternate resources; update patient's electronic record; provide monthly reports to supervisor.
• Continually research all alternate resources, exploring all available options for patient coverage; ensure application and information on alternative resources are readily accessible to the patients.
• Assist patients and their families with processing all applications for alternate resources. Provide interpretation of the rules and regulations from the organization supplying the benefit, as well as the rules governing Tribal/IHS services. Review with patients what is covered and how to use those services.
• Serves as back up for Patient Registration and other position as directed.
• Readily accepts referrals from Patient Registration to assist patients.
• Must comply with federal laws and regulations as required by the Health Insurance Portability and Accountability Act (HIPAA) and the Privacy Act of 1974.
• Performs related duties as assigned.
• Organize community enrollment events and actively participate in other community programs events.

Requirements

• Participate in Core Connection training and apply GPTLHB Core Connections concepts and practices in their work.
• Knowledge of and ability to apply alternate resources regulations.
• Knowledge of various third-party payers, applications processes, and eligibility requirements.
• Knowledge of computers and job-related software programs and office equipment.
• Knowledge of customer service principles.
• Ability to work with personal computer and utilize a variety of software applications.
• Ability to communicate clearly and effectively, both orally and in writing.
• Ability to effectively meet and communicate with the public.
• Ability to organize the multiple demands of the job.
• Ability to drive a motor vehicle in adverse weather conditions.
• Skill in providing exceptional customer service.
• Skill in prioritizing and planning.
• Skill in interpersonal relations.
• Skill in the maintenance of files and records.
• Skill in the use of such office equipment as a computer, scanner, fax machine, and copier.
• Skill in oral and written communication.

Minimum Qualifications

1. High school diploma or equivalent.
2. One (1) year of related experience to understand and perform the major duties of the position, and to be able to answer questions and resolve problems.
3. Must successfully pass a criminal and background check, and a pre-employment drug screen.
4. Current valid driver's license.
5. Must carry SD State minimum vehicle insurance.

The GPTLHB is a tribal organization which follows tribal preference laws. It is our policy to give preference to qualified Indian/Tribal candidates over qualified non-native candidates in hiring decisions, if all other qualifications are equal.

Employment is contingent upon the outcome of all required criminal background checks.

Compliance with our Employee Health Procedure is a condition of employment. You are required to agree that you will comply with all job-related employee health screening and immunizations prior to your first day of employment. Jobs require that you have documentation that you have completed the following immunizations prior to your first day of employment: MMR (Measles, Mumps and Rubella, Varicella (Chicken Pox), Hepatitis B, Influenza, T-dap (Tetanus - Diphtheria - Pertussis), and COVID-19 vaccination is required.