Patient Health Benefits Specialist

About the role

This position is expected to perform a higher level of generally more complex job-specific responsibilities from Health Benefits Specialist I. The Health Benefits Specialist is responsible for providing frontline health benefits enrollment to patients. Serves as a resource and referral resource for patients for initiating health care coverage.

Responsibilities

• Determines whether patients currently have a third-party payer.
• Screens and evaluates whether patients may qualify for known payer sources such as Medicaid, Medicare, VA, Federal Insurance Marketplace, Sliding Discount, and provides assistance for the enrollment process.
• Achieves the goal of increasing the number of patients enrolled with a third-party payer.
• Provides exceptional customer service in assisting patients enrolling in third party payers including Medicaid, Medicare, Denali Kid Care, VA, Federal Insurance Marketplace, and Sliding Discount.
• Enters data into MapsIQ health benefit tracking software and other systems.
• Maintains statuses from initiation to resolution and tracks additional data elements as necessary.
• Distributes health benefits material to patients, community members, partner organizations and businesses to build coverage option awareness.
• Collaborates with local and regional organizations and Tribal Nations to build awareness of coverage options.
• Completes and attends all required training programs and participates in conference calls, webinars or other professional or team development activities.
• Reviews, verifies, and confirms current third-party payer information in EHR.
• Supports the Health Benefits department with administration assistant type work including mail outs, data clean up, and other assigned duties.
• Coordinates and leads small scale projects.
• Facilitates educational events and presentations.
• Makes meaningful improvements to services, program, processes, and organizational effectiveness that creates new value for patients and employees.
• Acts as a resource, mentor, and trainer for entry-level Health Benefits Specialist I personnel and Patient Access Representatives, as appropriate.
• Orients new Health Benefits Specialist I staff to the department and SEARHC systems and processes.
• Communicates effectively with patients, physicians, and/or other departments regarding delays or issues relating to health insurance programs.
• Works closely with the Financial Counselors and Patient Access team to ensure coverage is current and documented appropriately in the record.
• Responds to inquiries regarding status of health coverage by assessing the request and evaluating the circumstances to provide the needed information.
• Communicates effectively with patients, physicians, and/or other departments regarding delays or issues relating to authorizations, PRC Travel and patient appointments.
• Maintains strict confidentiality at all times.
• Identifies compliance/ethics issues and brings forth recommendations for operational improvement.
• Ensures successful adherence to policies, procedures and changes to the organization.
• Completes and supports additional patient access related activities as assigned.
• Makes recommendations for FAP/HRSA approval.

Qualifications

• High School Diploma or equivalent – required.
• Bachelor's degree or 3+ years benefits enrollment experience or equivalent combination of education and experience or demonstrated proficiency.
• Certified Application Counselor (CAC) with CMS or obtain within 45 days of hire.
• Medicare Counselor Certification or obtain within 6 months.
• Completion of Department of Veterans Affairs-Tribal Veteran Representative training or obtain within 1 year of hire.

Skills

• Effective oral and written communication skills.
• Skills in using a database.
• Performs job with minimal supervision and demonstrates problem-solving skills.
• Skills in operating a computer utilizing a variety of software applications.
• Actively looks for ways to help people.
• Comfortable with ambiguity, exhibits good decision-making and attention to detail.
• Develops and maintains effective relationships through clear, encouraging, and timely communication.
• Excellent interpersonal skills and has the ability to interact on a professional level with individuals from diverse backgrounds.
• Multi-tasks and works independently in a fast-paced environment.
• Responds quickly in urgent situations with attention to detail.
• Problem solves and uses conflict resolution skills.
• Prioritizes work in multi-tasking in a fast-paced office setting with many interruptions.
• Self-starts and is willing to learn.
• Reads and comprehends simple instructions, short correspondence, and memos.
• Demonstrates time-management, organizational, and customer service skills.

Benefits

SEARHC offers generous benefits, including retirement, paid time off, paid parental leave, health insurance, dental, and vision benefits, life insurance and long and short-term disability, and more.

Pay

$25.00 - $33.71

Schedule

M-F 8-5