Contact Representative

Tohono O'odham Nation Healthcare•Sells, AZ

About The Position

The Contact Representative assists individuals and families in applying for alternate resources and navigating benefits options, eligibility conditions, and reporting requirements. The role identifies patients who have or may qualify for alternate resources and advocates for their effective use. It is located 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 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.

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 ability to perform the duties.
Knowledge of Tohono O'odham culture, customs, and traditions.
Knowledge of the policies and procedures of Medicare/Medicaid, Social Security Administration, county DSS offices, tribal programs, and related agencies.
Knowledge of establishing registers for eligible patients and of business office and Coordinated Care Branch routine operations.
Knowledge of the Privacy Act of 1974 and the requirement to maintain confidentiality of administrative, medical, personnel, and other pertinent records and information.
Knowledge of eligibility requirements for Medicare, Medicaid, SSI, the Migrant Workers' Health Fund, I.H.S. Direct Care Eligibility, and I.H.S. Contract Health Services Eligibility.
Tact and ability to work effectively with patients from diverse backgrounds and health care professionals across disciplines.
Ability to analyze private insurance benefit packages and communicate patient and Health Center utilization options.
Ability to conduct in-depth patient interviews to determine eligibility or alternate funding.
Ability to explain what information is needed and why, and to determine whether the information is accurate.
Ability to determine eligibility for alternate resources.
Ability to compile and write reports and review schedules and data printouts.
Ability to maintain a positive public-relations attitude and a cooperative, considerate approach toward others.
Ability to follow directions, absorb material, work independently, and meet strict timelines.
A criminal background check, National FBI fingerprint check, and 39-month driving record review are required upon recommendation for hire.
May be required to possess and maintain a valid driver's license, with no DUIs or major traffic citations within the past three years.
If required to operate program vehicles, must meet the Tohono O'odham Nation tribal employer's insurance requirements for a driver's permit.
May be required, based on department needs, to demonstrate fluency in both the Tohono O'odham language and English.

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.
Identify patients who have or may qualify for alternate resources by implementing screening methods and interviewing patients or families.
Work with staff to identify and use available alternate resources for the Tohono O'odham Nation population.
Advise and assist individuals and families with applications for alternate resources and with related questions or situations.
Explain benefit options, qualifying conditions, reporting requirements, rights, and benefits; tactfully advise patients about non-payment or claim approval.
Work with the Social Security Administration, local county and tribal agencies, and other programs to establish or verify eligibility for Medicare, AFDC, SSI, and other resources.
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, and with social services and other disciplines to develop eligibility registers.
Assist patients with alternate-resource applications, including transportation and interpretation of rules and regulations.
Intervene with third-party sources on patients' behalf and follow up on pending eligibility claims in coordination with families and agencies.
Compile and write reports from internal and external documents, and review schedules and data printout reports.