Patient Benefits Coordinator

Omaha Tribe of Nebraska•Macy, NE

4d•$18 - $19

About The Position

The Patient Benefits Coordinator identifies patients who are eligible for alternate resources, assists with enrollment, and advocates for Indian patients in effectively using available healthcare benefits. The coordinator works with patients, families, Tribal programs, healthcare staff, and outside agencies to establish eligibility, obtain benefits, and support access to healthcare resources. The position supports access to programs including Medicare, Medicaid, Veterans Administration benefits, third-party liability, CHIP, TANF, WIC, Supplemental Security Income, and other applicable resources. It also maintains patient information and encounter documentation in the Electronic Health Record (EHR) and Resource and Patient Management System (RPMS), protects patient confidentiality, and serves as backup for Patient Registration as needed. The role requires a high school diploma or GED and an associate degree in Business or a related field, or an equivalent two years of office experience, preferably in healthcare. A valid state driver’s license and the ability to maintain insurability are also required. Indian Preference and the Tribal Employment Rights Ordinance (T.E.R.O.) will be practiced; all qualified applicants will be considered.

Requirements

High school diploma or GED.
Associate degree in Business or a related field, or an equivalent two years of experience working in an office setting, preferably in a healthcare environment.
Valid state driver's license and ability to maintain insurability.
Knowledge of the operations, priorities, and objectives of alternate-resource programs.
Ability to stay current with changes in alternate-resource eligibility requirements, regulations, and policies.
Working knowledge of third-party resources and relevant agencies, including Medicare, Medicaid, the Social Security Administration, county Department of Health and Human Services offices, and Tribal programs, including their procedures, forms, and eligibility requirements.
Practical knowledge of medical terminology and a general understanding of ICD-10-CM and CPT coding systems.
Knowledge of applicable alternate-resource regulations, including P.L. 94-437, Title IV of the Indian Health Care Improvement Act, Indian Health Service policies and regulations on alternate resources, 42 CFR 36.21(a) and 36.23(f), and P.L. 99-272, the Federal Medical Care Cost Recovery Act, as applicable to the position.
Ability to communicate effectively with patients, families, healthcare personnel, Tribal programs, government agencies, and outside organizations.
Ability to maintain accurate records, protect confidential information, and follow established policies and procedures.
Ability to organize work, follow up on pending eligibility matters, and assist patients with complex enrollment and benefits questions.
Ability to use electronic health records and patient management systems to update and maintain accurate patient information.

Responsibilities

Advocate for Indian patients in effectively using alternate resources, including Medicare, Medicaid, Veterans Administration benefits, third-party liability, CHIP, TANF, and other applicable programs.
Work with Patient Registration Clerks to screen patients for potential alternate-resource eligibility when appointments are scheduled.
Identify potentially eligible patients through screening, interviews, and eligibility verification.
Coordinate with CTCHEC staff to identify and use alternate resources available to the Indian population.
Meet weekly with Purchased/Referred Care staff to identify patients who may qualify for additional third-party resources and coordinate follow-up.
Assist individuals and families with applications, enrollment, and effective use of alternate resources.
Coordinate with the Social Security Administration to establish eligibility for potential Medicare recipients.
Work with local Department of Health and Human Services offices, Tribal offices, and other agencies to establish eligibility for Medicare, Medicaid, pregnancy-related coverage, WIC, TANF, Supplemental Security Income, and other programs.
Verify eligibility with the appropriate Social Security Administration office, Department of Social Services, State Medical Assistance Office, or other responsible agency.
Interview Medicare- and Medicaid-eligible patients to explain their benefits and entitlements when receiving services through Tribal 638 and Indian Health Service facilities.
Collaborate with Social Services and other departments to identify potentially eligible patients, including elderly patients whose health status or circumstances may indicate eligibility.
Guide patients through applications, program requirements, eligibility rules, and enrollment procedures.
Update and maintain accurate patient demographic information in the EHR and RPMS.
Follow up on pending eligibility determinations and applications with patients, families, and outside agencies.
Perform patient advocacy and representative functions, including assisting with applications, conducting appropriate home or hospital visits, and explaining program requirements and regulations.
Provide transportation assistance to appropriate government or agency offices when necessary and authorized.
Research and maintain current information about alternate-resource programs, eligibility requirements, policies, and regulations.
Assist pregnant patients with Medicaid presumptive eligibility and private insurance eligibility, as applicable.
Provide advocacy and benefits assistance to patients using the Omaha Tribal Dialysis Unit.
Serve as backup for Patient Registration and perform related duties as needed.
Maintain patient confidentiality and comply with applicable privacy requirements, organizational policies, and procedures.
Document all patient encounters in RPMS page 5 accurately and completely, in accordance with established procedures.
Perform other related duties as assigned.