Patient Benefits Coordinator (43127)

Under general supervision of the Patient Benefits Supervisor, the Patient Benefits Coordinator is responsible for maximizing use of alternate resources in order to support collections for payment to the facility and its satellite clinics for direct care visits and to minimize Contract Health Services costs for referred care. Uphold the principles of WIHCC’s Vision, Mission, and Value Statements. Maintains confidentiality of all privileged information at all times.

This list of duties and responsibilities is illustrative only of the tasks performed by this position and is not all-inclusive.

Essential Duties & Responsibilities:

• Maintains regular attendance and punctuality.
• Identifies patients directly or via referral for direct care by implementing a screening process and incorporating interview methods to verify resources.
• Assists individuals and families with alternate resource applications, to include but not be limited to AHCCCS; KidsCare; Medicare; Medicare Cost Sharing Program; Long-term care; Social Security Benefits; Arizona Breast & Cervical Cancer Treatment; Pregnant Women; Veterans Health Benefits; Marketplace; and other potential payers.
• Establishes and verifies eligibility for Alternate Resources for the patients.
• 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 Plus interfaced with the Marketplace) 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 and works closely with families and agencies to see that the patient is not discriminated against as they are Indian Health Service (IHS) recipients.
• Performs outreach to the community regarding enrollment activities and educate community members at health fairs, chapter houses, school, etc.
• As a Certified Application Counselor; employee is certified to assist consumers in understanding new programs; taking advantage of consumer protections, and navigating the health insurance system to find the most affordable coverage that meets the consumer’s needs.
• Utilizes professional communication techniques in working with other departments and outside agencies.
• Performs continuous research and updating of information involving changes in rules and regulations for Alternate Resources, which includes attending Health and Human Services (HHS) training and webinars.
• Works closely with Patient Access staff, Purchase Referred Care, and Revenue Cycle for updates, corrections, and changes of status with each alternate resource plan. Follows up with benefits coordinators at other agencies to ensure enrollment takes place on hospitalized patients.
• Performs patient contact including home visits, hospital visits and community to ensure patient education, completion of applications, and review of necessary documents to ensure completion.
• Attends managed care meetings and other meetings related to Patient Benefits. Provides written and verbal weekly reports for referred care patients to the committee. Tracks on a written format direct and referred care activity and workload on a daily basis.
• Follows all guidelines of Privacy Act and HIPAA.
• Requires completion of tasks or duties assigned by a supervisor.