Patient Benefits Coordinator (MCR Part D Enrollee)

POSITION SUMMARY

The primary purpose of this position is to perform a major segment of the accounts receivable management functions to the Patient Accounts sections of the Medicare and Marketplace Sponsorship Program with Patient Benefit Coordination Department. This position requires the ability to work under conditions of frequent interruptions, be autonomous, collaborative and willingness to work a flexible schedule. Ensures applicable federal, state, local and organizational privacy laws and regulations are followed with issues related to Health information, confidentiality, release of information and patient rights.  Assist uninsured individuals in determining their Medicare Part D eligibility, age 65 and older; facilitate the selection of and/or other state/public benefit programs; also provides educational services for patients.

NECESSARY QUALIFICATIONS

Education:

High school diploma or GED

Experience:

One (1) year of experience working with alternative resources in a healthcare setting (AHCCCS/ALTCS, Medicare, State Programs, Social Security/disability, Marketplace/Medicare Part D sponsorship program, etc.)

Other Skills and Abilities:

A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas:

• Positive working relationships with others
• Possession of high ethical standards and no history of complaints
• Reliable and dependable; reports to work as scheduled without excessive absences
• Ability to work under conditions of frequent interruptions and availability to work flexible schedule
• Possesses and employs an ability to communicate with patients and families during time of emotional and physical stress
• Good oral and written skills and computer literacy for online enrolment assistance
• Must become Certified Application Counsellor (CAC) within 2 weeks from date of hire (depending on department)
• Must complete up to 30 hours of an HHS-developed training program and pass an exam within 2 weeks from date of hire
• Completion of and above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job
• Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job
• Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job
• Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading, or incomplete information, as determined by TCRHCC.

MENTAL AND PHYSICAL EFFORT

The physical and mental demands described here are representative of those that must be met by an  employee to successfully perform the essential functions of this job.  Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Physical:

Work is mostly sedentary, must be able to continuously sit, stand, walk, drive, bend, twist, maintain balance, and reach as well as frequently kneel and crouch. The work may require the ability to frequently carry items such as books, papers, and related documents or files weighing up to 10 lbs. and occasionally push/pull up to 10 lbs. of items. Must be able to continuously perform simple grasping, firm grasping, and fine manipulation of both hands as well as use the keyboard. Sensory requirement for position includes far vision, near vision, color vision, depth perception, seeing fine details, hearing normal speech, hearing overhead pages and telephone use.

Mental:

Must be able to prioritize and use good judgment; and be able to coordinate a variety of issues with intermittent interruptions.  Must have ability to continuously cope with high levels of stress, make decisions under high pressure, cope with anger, fear, hostility of others in a calm way, concentrate, handle high degree of flexibility, work alone, demonstrate high degree of patience, adapt to shift work, and work in areas that are close and crowded. Must also have the ability to manage altercations frequently. Must accept a flexible schedule to meet unit needs.

Environmental:

While in this position you may continuously be exposed to infectious diseases and occasionally to extremes in temperature or humidity and loud noises.

ESSENTIAL FUNCTIONS (Filing Functions):

1. Responsible for the accurate maintenance of a centralized file system for patient benefit coordinator files in the business office. Maintain the central file system in an alpha sequence by patient name in a readily retrievable fashion.
2. Responsible for the creation of patient financial file folders to be utilized in the business office for maintaining all financial information pertinent to each patient encounter or admission.
3. Controls receipt of registration documents, explanation of benefits copies for placement in the patient benefit folder. Places materials into appropriate patient benefit folder.
4. Pulls and distributes patient benefit folders to the appropriate personnel.
5. Locates patient financial folders needed to respond to correspondence received by Medicare Part D/Marketplace mailings and distributes to the appropriate staff.
6. Handles the re-filing of all patient financial folders in the master file system.
7. Copies and files remittance advice copies for government and state programs in patient financial folders.
8. Handles all incoming mail and its distribution as well as all outgoing departmental mail.

ESSENTIAL FUNCTIONS (Patient Benefit Coordinator Functions):

1. Assist patients in application for and use of alternate resources; work closely with Patient Financial Services and other staff in identifying all alternate resources available. Resources are Medicare, Medicaid, Arizona Health Care Cost Containment System (AHCCCS), Department of Veterans Affairs, Bureau of Employment Compensation, Third Party Liability, Workers’ Compensation, Children’s Special Health Services, Aide to Families with Dependent Children and assist with Marketplace/Medicare Part D enrollment thru the SEP with Medicare.
2. Establishes and verifies eligibility for alternate resources for the patients; must work closely with the Social Security Administration Offices (local and regional), Tribal Offices, Community Department of Welfare or Human Resources, Department of Social Services, Stat Medical Assistance Office and other appropriate agencies.
3. Provide information on rights and benefits of resources; advise patients of non-payment or denial of claims. If denials or other rejections occur, incumbents will intervene on patient’s behalf in disputing and debating the denial by third party sources.
4. Visits with patients to finalize documents necessary for assistance approval.  Obtains legally relevant medical evidence, physician statements and all other documentation required for eligibility determination.  Submits patient's applications accurately online (Health E/VA &etc.) and to the separate governmental agencies, follows application status to completion and updates account with verified third party information. Follows up on all pending applications, works closely with families and agencies to see that the patient is not discriminated against as they are Indian Health Service (IHS) recipients and closely monitoring and tracking all Medicare Part D/Marketplace enrollment for statistics reporting.
5. Performs a variety of patient representative functions including completion of applications for Marketplace/Medicare Part D, alternate resources (Medicaid, VA, and Disability), making hospital visits to interview patients, verify eligibility with Social Security Administration Offices, and interpreting rules and regulations for alternate resources for patients.
6. Perform continuous research and updating information involving changes in rules and regulations for alternate resources, which includes attending Health and Human Services (HHS) training. Will attain knowledge of total program operations, the priorities and goals of the Alternate Resources program. Will keep abreast of current changes in policies, regulations on alternate resources eligibility, medical terminology, and financial coding.
7. Directs educational meetings with groups from 5 – 25 participants by planning, delivering instructional materials and speaking.
8. Refers consumers seeking assistance to other Marketplace resources (i.e. referring to toll-free Marketplace Call Center or to another CAC can better serve the consumer). This also includes assisting patients/consumers who reside out of state by referring them to appropriate contacts in the patient/consumer’s State.
9. Provides information and application assistance in a fair, accurate, and impartial manner. Such information must acknowledge other health programs such as Medicaid and Children's Health Insurance Program (CHIP); facilitates Marketplace/Medicare Part D enrollment.
10. Provides referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under Section 2793 of the PHS Act, or any other appropriate State agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage.
11. Provides information in a manner that is culturally and linguistically appropriate to the needs of the population being served; meets Culturally & Linguistically Appropriate Services (CLAS) standards.
12. Requires interpretation of third-party billing/coverage requirements for patients, community events and providers.
13. Performs other duties as assigned.