Patient Benefits Coordinator (MCR Part D Enrollee)

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 perform a major segment of the accounts receivable management functions for the Patient Accounts sections of the Medicare and Marketplace Sponsorship Program within the Patient Benefit Coordination Department. This role requires the ability to work under frequent interruptions, autonomously and collaboratively, with a willingness to work a flexible schedule. The position ensures compliance with applicable federal, state, local, and organizational privacy laws related to health information, confidentiality, release of information, and patient rights. Additionally, this role assists uninsured individuals in determining Medicare Part D eligibility (age 65 and older), facilitates selection of state/public benefit programs, and provides educational services for patients.

Responsibilities

Filing Functions

• 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 alphabetical sequence by patient name for easy retrieval.
• Create patient financial file folders for maintaining all financial information pertinent to each patient encounter or admission.
• Control receipt of registration documents and explanation of benefits copies for placement in patient benefit folders.
• Place materials into the appropriate patient benefit folder.
• Pull and distribute patient benefit folders to appropriate personnel.
• Locate patient financial folders needed to respond to correspondence received by Medicare Part D/Marketplace mailings and distribute to appropriate staff.
• Handle the re-filing of all patient financial folders in the master file system.
• Copy and file remittance advice copies for government and state programs in patient financial folders.
• Manage all incoming and outgoing departmental mail.

Patient Benefit Coordinator Functions

• Assist patients in application for and use of alternate resources, working closely with Patient Financial Services and other staff to identify available resources such as Medicare, Medicaid, AHCCCS, VA, Bureau of Employment Compensation, Third Party Liability, Workers’ Compensation, Children’s Special Health Services, and Aide to Families with Dependent Children.
• Assist with Marketplace/Medicare Part D enrollment through the Special Enrollment Period (SEP) with Medicare.
• Establish and verify eligibility for alternate resources, collaborating with Social Security Administration Offices (local and regional), Tribal Offices, Community Department of Welfare or Human Resources, Department of Social Services, State Medical Assistance Office, and other agencies.
• Provide information on rights and benefits of resources; advise patients of non-payment or denial of claims and intervene on the patient’s behalf in disputing denials.
• Visit with patients to finalize documents necessary for assistance approval, obtaining legally relevant medical evidence, physician statements, and other required documentation.
• Submit patient applications accurately online (e.g., Health E/VA) and to separate governmental agencies, follow application status to completion, and update accounts with verified third-party information.
• Follow up on all pending applications, work closely with families and agencies to prevent discrimination against IHS recipients, and monitor/track Medicare Part D/Marketplace enrollment for statistics reporting.
• Perform patient representative functions, including completion of applications for Marketplace/Medicare Part D and alternate resources (Medicaid, VA, Disability), making hospital visits to interview patients, verifying eligibility with Social Security Administration Offices, and interpreting rules/regulations for patients.
• Conduct continuous research and update information on changes in rules/regulations for alternate resources, including attending HHS training.
• Attain knowledge of total program operations, priorities, and goals of the Alternate Resources program, staying current with policy/regulation changes, medical terminology, and financial coding.
• Direct educational meetings with groups of 5–25 participants by planning, delivering instructional materials, and speaking.
• Refer consumers to other Marketplace resources, including the toll-free Marketplace Call Center or other Certified Application Counselors (CACs) who can better assist them.
• Assist out-of-state patients/consumers by referring them to appropriate contacts in their state.
• Provide information and application assistance in a fair, accurate, and impartial manner, acknowledging other health programs such as Medicaid and CHIP, and facilitating Marketplace/Medicare Part D enrollment.
• Provide referrals to health insurance consumer assistance or ombudsman offices for enrollees with grievances, complaints, or questions about their health plan or coverage.
• Provide information in a culturally and linguistically appropriate manner, meeting CLAS (Culturally & Linguistically Appropriate Services) standards.
• Interpret third-party billing/coverage requirements for patients, community events, and providers.
• Perform other duties as assigned.

Requirements

Education

• High school diploma or GED.

Experience

• 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 program).

Other Skills and Abilities

• A record of satisfactory performance in all prior and current employment, as evidenced by positive employment references addressing:
  • Positive working relationships with others.
  • Possession of high ethical standards and no history of complaints.
  • Reliability and dependability; reporting to work as scheduled without excessive absences.
  • Ability to work under frequent interruptions and availability for a flexible schedule.
  • Ability to communicate with patients and families during times of emotional and physical stress.
  • Good oral and written skills, and computer literacy for online enrollment assistance.
• Must become a Certified Application Counselor (CAC) within 2 weeks of hire (depending on department).
• Must complete up to 30 hours of an HHS-developed training program and pass an exam within 2 weeks of hire.
• Successful completion of job interviews, demonstrating the ability to perform essential job functions.
• Successful completion of background and reference checks, including positive employment references from past and current employers.
• Successful completion of fingerprint clearance, physical examinations, and other screenings.
• Submission of all required employment-related documents free of false, misleading, or incomplete information.

Mental and Physical Effort

Physical Demands

The physical demands described here are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.

• Mostly sedentary work; ability to continuously sit, stand, walk, drive, bend, twist, maintain balance, and reach.
• Frequently kneel, crouch, carry items up to 10 lbs., and occasionally push/pull up to 10 lbs.
• Continuous use of simple grasping, firm grasping, and fine manipulation of both hands, as well as keyboard use.
• Sensory requirements include far vision, near vision, color vision, depth perception, seeing fine details, hearing normal speech, hearing overhead pages, and telephone use.

Mental Demands

• Ability to prioritize and use good judgment; coordinate a variety of issues with intermittent interruptions.
• Ability to cope with high levels of stress, make decisions under pressure, handle anger/fear/hostility calmly, concentrate, and adapt to a flexible schedule.
• Ability to work alone, demonstrate patience, adapt to shift work, and work in close, crowded areas.
• Ability to manage altercations frequently and accept a flexible schedule to meet unit needs.

Environmental Conditions

• Continuous exposure to infectious diseases.
• Occasional exposure to extremes in temperature or humidity and loud noises.