POSITION SUMMARY
Under the direct supervision of the Healthcare Operations Director, the Patient Benefits Coordinator shall be responsible for performing a variety of duties involving obtaining approval and utilization of patients' healthcare benefits and alternative resources involving clerical work related to patient registration and data entry.
ESSENTIAL FUNCTIONS
Determines patient eligibility for Shingle Springs Health & Wellness (SSHWC) patients and Direct Care and/or Purchased Referred Care (PRC) Services.
Know all applicable PRC policies, current levels of care, documentation of events, findings, confidentiality and security of records.
Ensure that policies and levels of care are suitable and administered appropriately.
Help identify and assist patients and their families to apply for alternate health insurance resources.
Works closely and cooperatively with administrative and clinical staff to maintain correct and complete patient's records.
Enters patient demographics and health insurance information data into the RPMS patient registration system.
Follows up with patients regarding Medicare, Medicaid, Medi-Cal, and private insurance changes, terminations, and eligibility.
Receive and process new patient registration applications. Enters patient information and health history in EHR.
Answers telephone and personal inquiries regarding patient registration and patient benefits coordination and PRC compliance issues.
Educate patients on their rights and responsibilities when using their health insurance, PRC program. Explain the importance of maintaining coverage, reporting changes, and the renewal processes.
Schedules appointments as needed.
Submits pre-authorizations for patients.
Other duties as assigned.
MINIMUM QUALIFICATIONS
Basic knowledge of Resource Patient Management System (RPMS) preferred.
Possess excellent computer skills and literacy including word processing (MS office).
Proficiency with information systems and experience working in an Electronic Health Record (EHR) environment.
Ability to work and communicate with a wide variety of people and positions in field, local, state, federal and private organizations within the health care profession.
Must possess excellent organizational, writing, and time management skills.
Must be able to maintain an extremely high degree of confidentiality and adhere to all requirements of the Privacy Act regulations.
Good oral and written communication skills.
Must possess and maintain a valid CA driver's license.
Post job offer: CPR/BLS certification, TB test, and annual flu shot (during flu season) are required as a condition of employment, unless a medical/religious accommodation request is provided and approved. Hepatitis B Vaccine will be offered at no cost to employees, but it is not required.
NATIVE PREFERENCE
Preference in hiring is given to either the most qualified applicant or a Native American candidate who meets the minimum qualifications. When two (2) or more Native American candidates have comparable qualifications, the following order of preference shall apply: (1) Members of Shingle Springs Band of Miwok Indians; (2) Spouses or domestic partners (certified through Tribal Court) of members of Shingle Springs Band of Miwok Indians; (3) Parents of children of the Shingle Springs Band of Miwok Indians; (4) All other documented Native Americans; (5) All other applicants in accordance with Title 25, U.S. Code, Section 472 and 473. Applicants claiming Native preference must submit verification of Indian eligibility.