Contact Representative

Tohono O•Sells, AZ

About The Position

The Contact Representative assists families and individuals in applying for alternate resources and navigating related problems, questions, and situations. The role explains available benefit options, qualifying conditions, and reporting requirements; identifies patients who have or may qualify for alternate resources; and advocates for patients in using those resources effectively. The position is within Tohono O'odham Nation Health Care and may require temporary relocation to other TONHC facilities, including Sells Hospital, Santa Rosa Health Center, San Simon Health Center, and San Xavier Health Center. The supervisor assigns work by outlining or discussing issues and defining objectives, priorities, and deadlines. The incumbent may train or instruct other employees but does not directly oversee or direct their work. Depending on the assigned area, some listed duties may not apply. The position works with patients, families, health care staff, government agencies, and community programs to screen for alternate-resource eligibility, support applications, verify benefits, and follow up on pending claims. Resources may include Medicare, Medicaid, Social Security programs, VA, private insurance, and other federal, tribal, county, or state programs. The incumbent maintains confidentiality of administrative, medical, personnel, and other sensitive information.

Requirements

Bachelor's degree in Public Administration, Business Administration, or a closely related field, and three years of work experience administering benefit plans; or an equivalent combination of training, education, and work experience demonstrating the ability to perform the duties.
Knowledge of Tohono O'odham culture, customs, and traditions.
Knowledge of policies and procedures of Medicare/Medicaid, Social Security Administration, County DSS offices, tribal programs, and related agencies.
Knowledge of establishing eligibility registers for patients in varied programs.
Knowledge of business office and Coordinated Care Branch operations for routine day-to-day duties.
Knowledge of the Privacy Act of 1974 and the obligation to maintain complete confidentiality of sensitive records and information.
Knowledge of eligibility requirements for Medicare, Medicaid, SSI, and the Migrant Workers' Health Fund.
Knowledge of eligibility requirements for I.H.S. Direct Care Eligibility and I.H.S. Contract Health Services Eligibility.
Tact and ability to deal effectively with patients of diverse backgrounds and health care professionals in different disciplines.
Ability to analyze private insurance benefit packages and communicate utilization options to patients and the Health Center.
Ability to conduct in-depth patient interviews to determine eligibility or alternate funding.
Ability to explain what specific information is needed and why, and to determine whether the information is as accurate as possible.
Ability to determine eligibility for alternate resources.
Ability to compile and write reports and analyze schedules and data printouts.
Ability to maintain excellent public relations and a cooperative, considerate attitude.
Ability to follow directions and absorb material necessary to perform assigned duties.
Ability to work independently and meet strict timelines.
Upon recommendation for hire, completion of a criminal background check and National FBI fingerprint check, including a 39-month driving record, is required.
May be required to possess and maintain a valid driver's license, with no DUIs or major traffic citations within the last three years.
If required to drive program vehicles, must meet the Tohono O'odham Nation tribal employer's insurance requirements for a driver's permit.

Nice To Haves

Depending on department needs, fluency in both the Tohono O'odham language and English may be required as a condition of employment.

Responsibilities

Advocate for patients in effectively using alternate resources, including Medicare, Medicaid, Department of Veterans Affairs, Bureau of Employment Compensation, private insurance, Children's Special Health Services, and AFDC.
Screen and interview patients or their families to identify people who have or may qualify for alternate resources.
Work with staff to identify and use resources available to the Tohono O'odham Nation population.
Advise and assist individuals and families with applications, questions, and related situations involving alternate resources.
Explain benefit options, qualifying conditions, reporting requirements, rights, and benefits; advise patients about non-payment or claims approval.
Establish potential Medicare eligibility by working with the Social Security Administration at local and regional levels.
Work with county and tribal agencies to establish eligibility for Medicare, AFDC, and SSI, and verify eligibility by contacting agencies and programs.
Interview patients eligible for Medicare and Medicaid to ensure they understand their entitlements.
Coordinate with patient registration and reception staff to screen for potential eligibility.
Work with social services and other disciplines to develop eligibility registers through activities related to determining the health status of elderly patients.
Assist patients with alternate-resource applications, including providing transportation and interpreting rules and regulations.
Intervene with third-party sources on patients' cases, including health care contacts and decision makers.
Follow up on pending eligibility claims and work with families and agencies to help ensure patients are not discriminated against because of their dual status as citizens and recipients of Tohono O'odham Nation hospital services.
Compile and write reports using documents from Coordinated Care Branch or Business Office internal and external sources.
Maintain confidentiality of administrative, medical, personnel, and other pertinent information.