Patient Benefits Coordinator

In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Preference in hiring and employment will be given to applicants who meet the necessary qualifications and are (1) enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe, (2) legally married to enrolled members of these tribes and meet residency requirements, or (3) enrolled members of other federally-recognized American Indian Tribes.

About the role

The primary purpose of this position is to identify patients who are eligible for Alternative Resources and serves as a liaison between the patient, hospital, and governmental agencies. This role requires autonomy, collaboration, and a flexible schedule. The position ensures compliance with federal, state, local, and organizational privacy laws related to health information, confidentiality, release of information, and patient rights. The incumbent assists uninsured individuals in determining eligibility, facilitates selection and application for Qualified Health Plans or other public benefit programs, and provides education services.

Responsibilities

• Assist patients in application for and use of Alternate Resources; works closely with Patient Financial Services and other staff in identifying all Alternate Resources available (e.g., Medicare, Medicaid, AHCCCS, VA, Workers’ Compensation, Children’s Special Health Services, and Affordable Health Care Act programs).
• Establish and verify eligibility for Alternate Resources for patients; collaborate with Social Security Administration, VA, Tribal Offices, Community Department of Welfare, and other agencies.
• Provide information on rights and benefits of resources; advise patients of non-payment or denial of claims and intervene on their behalf in disputes.
• Visit patients (ER, Inpatient, Outpatient) to finalize documents for assistance approval, obtain medical evidence, and submit applications accurately online (e.g., Health E Plus interfaced with the Marketplace). Follow up on pending applications to ensure patients are not discriminated against as IHS recipients.
• Perform patient representative functions, including completing applications for Alternate Resources, interviewing patients, verifying eligibility, and interpreting rules and regulations.
• Research and update information on changes in rules and regulations for Alternate Resources, attend HHS training and webinars, and stay current on policies, medical terminology, and CAC reporting.
• Direct educational meetings with groups of 5–25 participants by planning, delivering instructional materials, and speaking.
• Refer consumers to other Marketplace resources, including out-of-state contacts, and provide fair, accurate, and impartial assistance in selecting Qualified Health Plans or exemptions.
• Provide referrals to health insurance consumer assistance or ombudsman programs for enrollees with grievances or questions about their coverage.
• Provide culturally and linguistically appropriate information to meet CLAS standards.
• Ensure proper PPE is worn while on duty and follow CDC guidelines for donning, doffing, and disposal of PPE.
• Complete routine cleaning and decontamination processes for surfaces contaminated by communicable diseases.
• Perform other duties as assigned.

Requirements

• High school graduate or GED.
• One (1) year of experience working with alternative resources in a healthcare setting (e.g., AHCCCS/ALTCS, Medicare, State Programs, Social Security/disability, Marketplace/Medicare Part D sponsorship programs).
• Must become a Certified Application Counselor (CAC) within 2 weeks of hire and complete up to 30 hours of HHS-developed training, passing an exam within the same timeframe.
• Fluency in Navajo, Hopi, and/or San Juan Southern Paiute.
• Positive employment references demonstrating success in: positive working relationships, high ethical standards, reliability, and dependability.
• Ability to communicate with patients and families during emotional or physical stress, with strong oral, written, and computer literacy skills.
• Successful completion of background checks, fingerprint clearance, physical examinations, and other screenings.
• Submission of all required employment-related documents free of false or misleading information.

Skills

• Ability to work under frequent interruptions and handle a flexible schedule.
• Good judgment, critical thinking, and problem-solving skills.
• Effective communication with staff, providers, senior leaders, legal counsel, and external entities.
• Ability to cope with high stress, make decisions under pressure, and handle multiple priorities in stressful situations.
• Patience, adaptability to shift work, and ability to work in close or crowded environments.

Mental and Physical Effort

The physical and mental demands described are representative of those required to perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.

• Physical: Primarily sedentary work with continuous standing, sitting, walking, bending, twisting, and reaching. Ability to lift up to 25 lbs, push/pull up to 10 lbs, and perform simple/firm grasping and fine manipulation (e.g., keyboard use). Sensory requirements include far/near vision, color vision, depth perception, hearing normal speech, and telephone use.
• Mental: Ability to prioritize, use good judgment, and problem-solve. Must handle high stress, manage altercations, and adapt to frequent changes in a fast-paced environment.

Environmental

• May be continually exposed to infectious diseases and occasionally to loud noises.