Patient Insurance & Eligibility Specialist

Confederated Tribes of Grand Ronde•Grand Ronde, OR

13d•Onsite

About The Position

This role is responsible for collecting patient insurance benefits information, coverage, eligibility, primary care provider details, and co-payment amounts. The specialist will scan insurance cards into the Electronic Patient Management system (EPM) and coordinate eligibility of benefits with the tribe’s third-party payer (TPA), Purchased Referred Care, and the Skookum Health Assistance program staff. The position also involves limited scheduling and patient check-in, determining patient out-of-pocket expenses, collecting payments, and providing receipts for co-payments and payments on account for all GRHWC departments. A key responsibility is gathering eligibility information for all American Indian/Alaska Natives (AI/AN) receiving healthcare services, which includes collecting documentation and contacting other tribes to ensure compliance with Federal guidelines. The specialist will also collect necessary documentation from patients to determine eligibility for services related to pregnant women of PRC eligible fathers, such as birth certificates, certificates of Indian blood, Tribal ID cards, marriage certificates, or paternity statements. This role acts as a liaison between the individual, insurance, and the billing department, processes new patient paperwork, obtains signatures and necessary information, and handles waivers. Daily tasks include balancing cash and receipts, assisting with end-of-month reports for billing, posting payments into the EPM and patient accounts, and accurately entering updated patient demographics and insurance information. The specialist will also ensure new patient packets are completed before services, update address changes in EPM, assist patients with the patient portal, and follow emergency code calling protocols. Additionally, the role involves reviewing correspondence and eligibility letters, providing information on accessing services, alerting account notes for clinic staff, following procedures for patients with account alerts, and providing Patient Registration reports. General information about available services will be provided to the community. The authorized individual may transport patients in a company vehicle and perform other assigned duties.

Requirements

Requires a high school diploma or GED and a minimum two (2) years of post-high school specialized job skills training in the medical billing, accounting principles or other closely related accounts receivable/payable field.
OR equivalent combination of education, training and experience.
Must maintain a valid Oregon driver’s license or obtain one upon hire, qualify for the Tribe’s vehicle insurance, and provide proof of personal vehicle insurance.
Requires knowledge of accounting principles and practices.
Knowledge of ethical and legal requirements and restrictions pertaining to the maintenance of medical records, as well as facility policies, HIPAA and other federal regulations.
Requires knowledge of electronic patient management system (EPM) and standard office equipment such as fax machine, copy machine, visa machine, 10 key, and multi-line telephone.
Requires knowledge of Windows based PC system, or comparable.
Knowledge of and sensitivity to Native American culture is required.

Responsibilities

Collects patient insurance benefits information, coverage, eligibility, primary care provider, co-payment amounts, and scans insurance cards into Electronic Patient Management system (EPM).
Coordinates eligibility of benefits with the tribe’s third-party payer (TPA), Purchased Referred Care, and the Skookum Health Assistance program staff.
Limited scheduling and checking in patients.
Determines Patient out of pocket, collects money and provides receipts to patients for copayments, and payments on account for all GRHWC departments.
Gathers eligibility information for all American Indian/Alaska Natives (AI/AN) receiving health care for all GRHWC programs.
Includes collection of documentation, contacting other tribes.
Ensures that Tribal affiliation meet requirements of Federal guidelines for services.
Collects all necessary documentation from patients to determine eligibility for services available to pregnant women of PRC eligible fathers, i.e. birth certificates, certificate of Indian blood, Tribal ID cards, marriage certificates or paternity statements.
Acts as a liaison between the individual, insurance, and the billing department.
Processes new patient paperwork, obtains appropriate signatures, pertinent patient and insurance information, as well as waivers.
Balances cash and receipts to the cash register daily.
Assists with running end of month reports to report to Billing.
Posts payments into the EPM, into patient accounts daily.
Timely and accurately enters all updated patient demographics, insurance/alternate resource information into the EPM.
Assists in ensuring all new patient packets are completed and entered prior to receiving services.
Updates address changes in EPM from various departments such as Enrollment, ICW, and Pharmacy.
Assists patients with sign up and maintain accurate information within the patient portal.
Follows emergency code calling protocol for emergencies entering the HWC.
Reviews correspondence and eligibility letters for direct care and PRC members; provides information on how to access services.
Alerts account notes for Clinic staff.
Follows appropriate procedures for patients with account alerts.
Provides Patient Registration reports as requested.
Provides general information regarding services available to the community.
Authorized to transport native and/or non-native patients of the GRHWC in company vehicle as necessary.
Performs a variety of other duties as assigned by supervisor.