Patient Insurance & Eligibility Specialist

Job Title

Salary Pay Range: $24.60/hr.-$31.84/hr.

Essential Functions

• Collects patient insurance benefits information, coverage, eligibility, primary care provider, co-payment amounts, and scans insurance cards into Electronic Patient Management system (EPM).
• Coordinates eligibility of benefits with the tribe's third-party payer (TPA), Purchased Referred Care, and the Skookum Health Assistance program staff.
• Limited scheduling and checking in patients.
• Determines Patient out of pocket, collects money and provides receipts to patients for copayments, and payments on account for all GRHWC departments.
• Gathers eligibility information for all American Indian/Alaska Natives (AI/AN) receiving health care for all GRHWC programs. Includes collection of documentation, contacting other tribes.
• Ensures that Tribal affiliation meet requirements of Federal guidelines for services.
• Collects all necessary documentation from patients to determine eligibility for services available to pregnant women of PRC eligible fathers, i.e. birth certificates, certificate of Indian blood, Tribal ID cards, marriage certificates or paternity statements.
• Acts as a liaison between the individual, insurance, and the billing department.
• Processes new patient paperwork, obtains appropriate signatures, pertinent patient and insurance information, as well as waivers.
• Balances cash and receipts to the cash register daily. Assists with running end of month reports to report to Billing.
• Posts payments into the EPM, into patient accounts daily.
• Timely and accurately enters all updated patient demographics, insurance/alternate resource information into the EPM. Also, assists in ensuring all new patient packets are completed and entered prior to receiving services.
• Updates address changes in EPM from various departments such as Enrollment, ICW, and Pharmacy.
• Assists patients with sign up and maintain accurate information within the patient portal.
• Follows emergency code calling protocol for emergencies entering the HWC.
• Reviews correspondence and eligibility letters for direct care and PRC members; provides information on how to access services.
• Alerts account notes for Clinic staff. Follows appropriate procedures for patients with account alerts.
• Provides Patient Registration reports as requested.
• Provides general information regarding services available to the community.
• Authorized to transport native and/or non-native patients of the GRHWC in company vehicle as necessary.
• Performs a variety of other duties as assigned by supervisor.

Education, Experience, and Licenses

• Requires a high school diploma or GED and a minimum two (2) years of post-high school specialized job skills training in the medical billing, accounting principles or other closely related accounts receivable/payable field.
• OR equivalent combination of education, training and experience.

Driving Requirements

• Must maintain a valid Oregon driver's license or obtain one upon hire, qualify for the Tribe's vehicle insurance, and provide proof of personal vehicle insurance.

Qualifications, Registrations, and Certifications

• Requires knowledge of accounting principles and practices.
• Knowledge of ethical and legal requirements and restrictions pertaining to the maintenance of medical records, as well as facility policies, HIPAA and other federal regulations.
• Requires knowledge of electronic patient management system (EPM) and standard office equipment such as fax machine, copy machine, visa machine, 10 key, and multi-line telephone.
• Requires knowledge of Windows based PC system, or comparable.
• Knowledge of and sensitivity to Native American culture is required.

Environmental Factors and Physical Requirements

• Continually requires the ability to express or receive detailed information or important instructions through oral communication.
• Continually requires working with fingers rather than the whole hand or arm. Requires repetitive movement of wrists, hands and/or fingers. Often requires walking or moving about to accomplish tasks.
• Requires standing and/or sitting for sustained periods of time, raising objects from a lower to a higher position and/or moving objects horizontally.
• Occasionally requires lifting of up to 20 pounds.
• This position is frequently subject to inside environmental conditions which provide protection from weather conditions, but not necessarily from temperature changes, and is occasionally subject to outside environmental conditions.
• Supports a safe work environment by performing all duties in accordance with Tribal safety policies and procedures, and Emergency Management Plan.
• Due to the nature of the interactions with other employees and the public we serve, employees may be required to provide documentation of, or receive, certain health vaccinations.
• May be called upon to serve as a Disaster Reservist during emergencies.
• Local travel is occasionally required. Travel outside of the state is infrequently required.

Background Check

• Candidates for this position will be subject to criminal and character background checks and may be subject to fingerprinting.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

Confederated Tribes of Grand Ronde