Patient Benefits Coordinator

Klamath Tribal Health and Family Services•Chiloquin, OR

5d•$18 - $31•Onsite

About The Position

The primary purpose of this position is to function as an advocate for patients in the effective utilization of alternate resources such as Medicare, Medicaid, Department of Veterans Affairs (DVA), Bureau of Employment Compensation (BEC), Private Insurance Billing (PIB, Children’s Special Health Services, Aid to Families with Dependent Children (AFDC), Oregon Health Plan, etc. The primary responsibility of this position is to ensure that all patients who are eligible for alternate resources are identified, contacted and encouraged to apply for and maintain eligibility for available benefits.

Requirements

High School Diploma or Equivalent.
A minimum of one (1) year of experience in customer service, administrative support, data entry, or a related field involving direct interaction with the patients, participants, vendors and the public.
Obtain and maintain Oregon Health Plan assister certification within 90 days of hire.
Obtain and maintain SHIBA (Senior Health Insurance Benefits Assistance) certification within 9 months of hire.
Possess and maintain a valid Oregon Driver’s License, (out of state applicants must receive ODL within 90 days of hire), have good driving record and be insurable by the Klamath Tribal Health & Family Services’ vehicle insurance policy.
Acquire and maintain BLS certification within 180 days of hire; strongly recommend certification within 90 days of hire, probationary period will be extended for a maximum of 180 days pending certification.
Excellent communication skills; understanding of Tribal services, alternate health resources and service terminology.
Willingness to drive in adverse weather conditions.
Maintain strict patient confidentiality and adhere to the standards for behavioral health record-keeping and HIPAA requirements.
Recordkeeping skills with the ability to complete required documentation and required written follow-up.
Submit to a background and character investigation, as per Tribal policy.
Immediately report to Human Resource any citation, arrest, conviction for a misdemeanor or felony crime.
Submit to annual TB skin testing and adhere to KTHFS staff immunization policy in accordance with the Centers for Disease Control immunization recommendations for healthcare workers.
Accept the responsibility of a Mandatory Reporter in accordance with the Klamath Tribes Juvenile Ordinance Title 2, Chapter 15.64 and General Council Resolution #2005 003, all Tribal staff are considered mandatory reporters.
Travel between Healing Place in Klamath Falls and the Medicine Place in Chiloquin, as needed.

Nice To Haves

Three (3) years experience working in a medical office is preferred.
Experience working with Native American programs is preferred.
Experience working with medical/records management is preferred.
Experience working with health insurance benefits is preferred.

Responsibilities

Determine eligibility of patients referred to by Klamath Tribal Health & Family Services’ staff. Provide a response describing initial action taken to the referring staff within three working days upon receipt of referral. Maintain chart notes within the EHR/PM Patient Benefits Notes section and Alternate Resource Master Log documenting all actions taken regarding referral.
Work closely with Patient Registration, Third Party Billing, Contract Health Services and other front-line staff to ensure all patient information is current, accurate and that all alternate resources are utilized.
Provide back up for Patient Registration and assist in maintaining current and accurate patient data in the database being utilized by Klamath Tribal Health. This will involve interviewing and screening new and existing patients and informing Patient Registration staff so that the appropriate changes can be made. The Patient Benefits Coordinator may make the changes with approval from the supervisor.
Ensure maximal identification of persons who have or are eligible for alternate resources by effectively implementing screening and interview methods.
Work closely with all facility staff in identification and proper utilization of all alternate resources available to all patients who utilize Klamath Tribal Health & Family Services, giving emphasis to those who reside in the Klamath Tribes’ Health Service area (Klamath County). Alternate Resources are those that provide direct health assistance for the client, for example Medicaid and Medicare.
Assist patients and their families with processing all applications for alternate resources, for example Medicaid and Medicare. 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. This may require occasional travel to the patient’s home to acquire documentation, assist with applications or to interview the patient for additional information.
Transmit all applications for alternate resources to the appropriate agency; track and monitor the processing of applications. Document all activities within the EHR/PM Patient Benefits Notes section and Alternate Resource Master Log.
Track all applications for alternate resources throughout the processing period. Follow up to ensure all required information and documentation have been submitted, monitor application status and renewal/end dates, and take timely action to prevent missed deadlines or lapses in coverage. The Patient Benefits Coordinator will contact the patient following application submission to identify and obtain any additional information or documentation needed to complete the application process. Document all follow-up attempts, communications, and actions taken in accordance with department procedures.
Follow up on all pending eligibility claims and work closely with families and agencies to see that patients are not discriminated against because of their dual role as a citizen and as a Tribal Health/IHS recipient.
Keep patients and staff up to date on regulatory changes by researching, updating and sharing information on alternate resources.
Document all work activities on finding/maintaining/assisting with alternate resources on the “notes page” of the patient’s chart in the current database system being utilized by Klamath Tribal Health.
Develop and maintain a network of contacts in local, state and federal agencies to better assist patients in developing other resources, including all agencies and organizations that provide alternate resources for health care. Identify a contact at the agency who can assist the patient with detailed applications for Social Security Administration (SSA), Department of Human Services Tribal programs AFDC, Supplemental Social Security Income (SSI), etc.
Responsible for maintaining an accurate daily log of activities; log of visits with patients noting the chart number, the time and what action was taken, (i.e. home visit to complete application, advocate work at the local DHS office, etc.); submit log to Patient Services Manager for review each week.
Assist clients with initial applications for disability determination through the Social Security Administration by providing information on how to apply online, by mail or in-person. Staff may also assist the client in making contact with an agency or individual of their choice who specializes in disability assistance.
Assist clients in enrolling into health insurance plans through Oregon’s state-based marketplace.
Submit monthly and annual reports to the Patient Services Manager. Submit quarterly reports to the Office of Medical Assistance Programs as agreed to by contract.
Assist patients eligible for KTHFS Tribal Premium Sponsorship Programs with applications for enrollment, relay information regarding program eligibility, and program benefits.
Screen upcoming KTHFS appointments (Medical, Dental, YFGC, etc.) daily, as assigned by the Patient Services Manager, to verify active health insurance coverage or potential eligibility for alternate resources for those who are uninsured. Place appropriate alerts in the patient’s chart and make reasonable efforts to screen the uninsured patients for potential alternate resources. Document screening efforts and outcomes in the patient’s EHR/PM notes section.
Attend meetings, trainings, and other professional development opportunities hosted by external collaborative entities when requested by Patient Services Manager.
Like all employees of the Klamath Tribes, the incumbent will be called upon to accomplish other tasks that may not be directly related to this position, but are integral to the Klamath Tribes’ broader functions, including but not limited to, assisting during Tribal sponsored cultural, traditional, or community events that enable the successful operation of programs and practices of The Klamath Tribes as aligned with The Klamath Tribes’ Mission Statement. Some of these tasks may be scheduled outside of regular work hours, if necessary.