Benefits Coordinator - PRC

SUMMARY

The primary purpose of this position is to identify tribal members with eligibility for alternate resources, assisting them with the enrollment process, act as an advocate and liaison in the effective utilization of alternate resources. This position seeks to increase the education, outreach, and enrollment of tribal members in a variety of federal, state, local, tribal health, social services, and veterans programs. This position motivates a collaborative effort of benefits coordination as a working component of the Purchased Referred Care Services. This includes case file review and updates/training as necessary for quality assurance of services provided and maintaining current information from and/all proposed alternate resources. Work in collaboration with the Clinic Applications Coordinator to maintain a minimum requirement of knowledge specific to RPMS/CHS Patient Registration. This position will assist with the administering the Purchased Referred Care (PRC) Services benefits and authorization for services based on severity, need and availability of funds.

MINIMUM QUALIFICATIONS

• Associate's Degree in Business Administration, Social Work, Health Administration or related field required.
• Must have direct experience and demonstrated proficiency working with Medicare Part A, B & D, Medicaid, SSI, VA, and other medical billing.
• Must have a valid unrestricted driver license and be insurable by the GTB insurance carrier.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Works closely with facility staff to identify all alternate resources available. Assists tribal members in application for use of alternate resources, and establishing and verifying eligibility for alternate resources.
• Responsible for working closely with local and regional Social Security Office, Tribal Offices, Community Department of Welfare, Human Services, Department of Social Services, State Medical Assistance Office and other appropriate agencies.
• Examines alternate resources available to patients under the Grand Traverse Band's Purchased Referred Care Services Program. Determines tribal members eligibility for Medicare, Medicaid, Department of Veterans Affairs, Worker's Compensation, private insurance, state programs, and any other applicable resources. This requires the application of Purchased Referred Care Services rules to determine eligibility.
• Builds and maintains close working relationships with agencies administering benefits to ensure maximum utilization, including contact through telephone, correspondence, and personal visits.
• Conducts personal interviews with tribal member and/or family member to determine potential eligibility for any alternate resources, as necessary.
• Provides and maintains up to date information with materials, enrollment forms, and information brochures regarding benefit programs, such as Medicaid, Medicare, Veterans, SSA, etc., and their eligibility requirements.
• Serves as a liaison and follows up on all pending applications, and works closely with families and agencies, intervening on patient's behalf in disputing and debating denials. Performs a variety of patient representative functions including completion of applications for alternate resources, making home/hospital visits to interview patients, arrangement for transportation, as necessary.
• Coordinates with organization's Elder, nutrition, health, and other social service programs to provide outreach to Elders on benefits for which they are eligible. Makes presentations at organizational events such as Elder Advisory Council Meetings and community gatherings. Prepares and submits information articles to Tribal and organizational newsletters.
• Assists tribal members and Elders with all benefits matters, including explaining policies and competing enrollment forms for various federal and state social service programs.
• Responsible for submitting and tracking completed forms to federal and state social service programs. Coordinates with other GTB staff and with tribal members to ensure that patient completes application in a timely manner.
• Investigates, analyzes and resolves a wide range of benefit issues, which include documentation of the steps taken in the resolution process. Alerts and coordinates efforts with other GTB staff.
• Assists with or develops and maintains a record keeping system to track client contact and benefit coordination efforts.
• Serves as an advocate for tribal members in their dealings with local, state, and federal agencies as well as with miscellaneous health care organizations that may impact eligibility for alternate resources.
• Maintains up-to-date knowledge of PRC Services program rules, regulations, goals and objectives. Keeps abreast of changes in regulations and policies on alternate resource eligibility of various third party resources (Medicare, Medicaid, Social Security Administration, County and Tribal programs, and other related agencies), including procedures and forms.
• Collaborate with PRC Services, Medical Assistant/Billing & Registry Clerk, and PRC's in assigned counties, and other appropriate GTB staff, to ensure smooth and complete processing of applications for health benefits.
• Provide training regularly as required.
• Maintains excellent communication with personnel from hospitals and health care provider offices throughout the six-county service area to ensure smooth processing of Medicaid eligible tribal members. Serve as the liaison to health providers for benefit-related questions, referrals, concerns, etc.
• Attends training as required, such as with State Health Insurance Programs, Benefits Agencies, Tribal or IHS Systems, Veterans Benefits, County, HIPPA, or other GTB services.
• Participates in Purchased Referred Care Services, quality improvement, utilization review meetings, and staff meetings as necessary. Performs and provides continuous research and updating of information involving changes in rules and regulation for alternate resources.
• Assist in file purge and application process of Purchased Referred Care Services and verify that PRC is payer of last resort.
• Participate in the development of Tribal Membership self-insurance program.
• Participate in long range health plans for the community and the health care delivery systems.
• Other duties as assigned.

OTHER SKILLS AND ABILITIES

• Knowledge of the benefit programs and eligibility requirements.
• Work requires proficiency in computer literacy, preferably in Microsoft Windows, Word, Excel and other Microsoft office products and data base applications. Must have or obtain proficiency in the Resource Management (RPMS) specific to Contract Health Work environment.
• Knowledge of GTB community.
• Extremely detail oriented to include time management and organizational skills that are critical.
• Ability to work well with a variety of people from differing backgrounds.
• Excellent communication skills for making complex information understandable.
• Willingness to work flexible hours at times.
• Willingness and ability to travel on a regular basis to satellite offices.
• Able to work independently.
• Must have reliable transportation and a valid Michigan driver's license.

EDUCATION AND/OR EXPERIENCE

Bachelor's Degree in Business Administration, Social Work, Health Administration or related field preferred, with a minimum of an Associates Degree. Must have direct experience and demonstrated proficiency working with Medicare Part A, B & D, Medicaid, SSI, VA, and other medical billing.

SUPERVISORY RESPONSIBILITIES

None, but may change in the future.

EQUIPMENT TO BE USED

General office equipment such as computer, calculator, copiers, fax, phone, etc.

TYPICAL PHYSICAL DEMANDS

Requires sitting, some lifting, reaching, and walking. Some lifting of small office equipment. Also requires manual dexterity to operate office equipment. Ability to drive long distances to satellite offices. .

TYPICAL MENTAL DEMANDS

Mathematical reasoning for understanding and working with basic financial requirements for benefits eligibility. Good problem solving ability and sound judgment when dealing with confidential information.

WORKING CONDITIONS

Primarily works in a typical office environment. Requires employee to frequently see clients in their homes.

COMMENTS

Native American Preference will apply. Must be willing and able to pass a background investigation and a drug and alcohol urinalysis as a condition of employment. Adherence to strict company policy in regard to confidentiality is a must.

The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Management retains the right to add or to change the duties of the position at any time. Any qualifications to be considered as equivalents in lieu of stated minimums require prior approval of the Director of Human Resources.

Current Openings for Benefits Coordinator PRC Jobs at Grand Traverse Band of Ottawa and Chippewa Indians