Patient Benefits Coordinator

Omaha Tribe of Nebraska•Macy, NE

About The Position

The Patient Benefits Coordinator identifies patients who may qualify for alternate healthcare resources, assists patients and families with eligibility and enrollment, and advocates for Indian patients’ effective access to available benefits. The role works with patients, families, Tribal programs, healthcare staff, and outside agencies to establish eligibility, obtain benefits, and support access to healthcare resources. Alternate resources include Medicare, Medicaid, Veterans Administration benefits, third-party liability, CHIP, TANF, WIC, Supplemental Security Income, and other applicable programs. The coordinator screens and interviews patients, verifies eligibility, helps complete applications, explains program requirements and benefits, follows up on pending determinations, and researches changes to relevant programs and regulations. The role maintains current patient information in the EHR and RPMS and documents patient encounters in RPMS. It also provides patient advocacy, including appropriate home or hospital visits and authorized transportation assistance, supports pregnant patients seeking presumptive Medicaid eligibility, assists patients using the Omaha Tribal Dialysis Unit, and serves as backup for Patient Registration.

Requirements

High school diploma or GED.
Associate degree in Business or a related field, or an equivalent of 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 remain current with changes in eligibility requirements, regulations, and policies governing alternate resources.
Working knowledge of third-party resources, including Medicare, Medicaid, the Social Security Administration, county Department of Health and Human Services offices, Tribal programs, and related agencies, 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 the effective utilization of 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 as appointments are scheduled.
Identify potentially eligible patients through screening, interviews, and eligibility verification.
Coordinate with CTCHEC staff and Purchased/Referred Care (PRC) staff to identify patients who may qualify for additional resources and arrange follow-up.
Assist individuals and families with applications, enrollment, and effective use of available alternate resources.
Coordinate with the Social Security Administration, Department of Health and Human Services offices, Tribal offices, DSS, State Medical Assistance offices, and other agencies to establish and verify eligibility.
Interview Medicare- and Medicaid-eligible patients to explain 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.
Explain program requirements, eligibility rules, and enrollment procedures to patients and families.
Update and maintain accurate patient demographic information in the EHR and RPMS.
Follow up on pending eligibility determinations and applications and work with patients, families, and agencies to resolve outstanding issues.
Conduct home or hospital visits as appropriate to interview patients and assist with eligibility and enrollment needs.
Provide transportation assistance to appropriate government 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 utilizing the Omaha Tribal Dialysis Unit.
Serve as backup for Patient Registration and perform related duties as needed.
Maintain patient confidentiality and comply with 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.