Patient Benefits Coordinator

Position Overview

As part of the Revenue cycle team, Patient Benefits Coordinators screen and verify third party eligibility to maximize reimbursement and facilitate revenue cycle improvement. They implement, organize and facilitate all aspects of third-party enrollment assistance to individuals and families. Patient Benefits Coordinators participate in public events to educate and share information on financial healthcare resources, coordination of benefits, and to assist with enrollments.

Duties and Responsibilities

Insurance Verification

• Responsible for verifying and documenting current patient eligibility and benefits with third-party payers prior to the patient visit.


• Monitor daily schedule to verify benefits and eligibility for any patients seen on the same-day.


• Work with the Revenue Cycle team and patients to ensure communication on payment expectations at time of service (i.e. co-pays due, more information needed).


• Provide problem solving assistance to Revenue Cycle Team regarding billing for all patients where billing problems are identified in the verification process, and through appeal efforts for authorization-related denials.


• Perform and document Discount Fee Program income verification checks as required by current policy and procedure.


• Determine patient eligibility for prescription “340B” program, issue cards, maintain Care Card database and tracking.


• Assist patients as requested by medical team in applying for manufacturer Prescription Assistance Programs (aka PAPA).


• Monitor for Worker’s Compensation-related appointments to ensure required billing information is in place.


• While reviewing future appointments, input Alaska Breast & Cervical Insurance for any Well Woman Exams.


• Provide insurance-related training and back-up support to Patient Service Representatives.


• Coordinate SVT Purchased-Referred Care (PRC) application process and maintain current PRC-eligible list in conjunction with designated PRC coordinator of SVT. Coordinate Alaska Native Medical Center (ANMC) patient registration process and assure that all Alaska Native/American Indian (AN/AI) patients/partners have registered and/or updated their demographics.

Enrollment Assistance

• Meet with individuals and families to assist with eligibility for, and enrollment into, the Healthcare Marketplace, Veteran’s Health Benefits, Medicare, Medicaid, and Children's Health Insurance program coverage options. Provide information about enrollment options, interpret standards and guidelines, answer questions, obtain consent for services and offer assistance in a manner that is culturally and linguistically appropriate to diverse community residents and accessible to individuals with disabilities.


• Actively collaborate with staff to identify uninsured patients and connect them with health care resources for which they may be eligible.


• Document and maintain record of enrollment/eligibility encounters (application tracking system) with individuals and families. Conduct follow up on the progress of enrollment and help troubleshoot enrollment barriers. Track number of eligibility assistance provided and successful enrollments in the Healthcare Marketplace, Veteran’s Health Benefits, Medicare, Medicaid, and other plans.


• Complete and submit quarterly Tribal Medicaid Administrative Claiming (TMAC) reports.


• Maintain current knowledge of local, regional, state and national resources.


• Complete required federal and/or state consumer assistance training to provide fair, accurate and impartial assistance.


• Provide new employee onboarding training regarding the Health Insurance Marketplace, Medicaid, Denali KidCare and Veteran’s Health benefits.


• Develop materials, disseminate, and collaborate with the local community to provide education on the importance of health care coverage and addressing barriers to enrollment at community events. 

Other Duties as assigned

Specifications (Certifications, licensure, prerequisites, special considerations)

• Skill in working independently and as a team member.


• Skill in establishing and maintaining cooperative working relationships with others.


• Ability to work with patients who are in distress and problem solve in a calm, professional manner.


• Strong computer and communication skills are a must.


• Strong attention to detail and concern for completing tasks correctly and efficiently.


• Ability to prioritize responsibilities according to urgency and importance.


• Maintains a professional positive attitude at all times.


• Proficient in medical terminology.


• Adhere to HIPAA regulations as outlined in SVTHW policy and procedure, state and federal regulations to protect and maintain personal health information.

Job Requirements

Education:

High School Diploma or equivalent required; Associates degree preferred.

Experience:

· Three year’s experience working with the public in an office setting; or equivalent combination of education and experience. 

· One year experience with Medicaid, Medicare and commercial insurances directly. 

· Familiarity with federal, state, and local resources available to meet the health and social needs of patients. 

· Knowledge of medical billing procedures and medical terminology. 

· Knowledge of HIPAA, and other state and federal regulations governing healthcare practices.

Certifications/ Licensure:

Preferred upon hire, or willingness to obtain during employment:

· Certified Medicare Counselor (State of Alaska)

· Health insurance Marketplace – Certified Application Counselor

· Tribal Veteran Representative (TVA)

· AAAHAM Revenue Cycle Specialist Certification

Travel:

While position is based in Homer, must be able and willing to travel to satellite clinics in Anchor Point and Seldovia to facilitate customer access to enrollment and eligibility assistance.

Computer Requirements:

Proficiency in Microsoft Office (Word, Excel, PowerPoint) and Outlook.  Proficiency with scheduling / insurance verification software.

Screening Requirements:

FBI Fingerprinting

Pre-employment Drug Testing

Pre-employment Background Screening