Patient Benefits Coordinator

$48,110 - $72,155/Yr

Great Plains Tribal Chairmen's Health Board - Rapid City, SD

Full-time - Entry Level

Rapid City, SD

Professional, Scientific, and Technical Services

About the position

The Patient Benefits Coordinator position at Oyate Health Center is a vital role focused on advocating for patients and ensuring they effectively utilize alternate resources for their healthcare needs. This position is responsible for identifying patients who are eligible for various benefits and guiding them through the application process. The coordinator will work closely with patients, families, and healthcare staff to maximize the utilization of available resources, ensuring that all eligible patients are contacted and encouraged to maintain their eligibility for benefits. In this role, the coordinator will determine patient eligibility for direct services and alternate third-party resources through effective screening and interview methods. They will review Purchased Referred Care (PRC) referrals, verify patient eligibility for services, and develop a network of contacts within local, state, tribal, and federal agencies to assist patients in accessing additional resources. The coordinator will also follow up on pending eligibility claims, assist patients in appealing denials from third-party resources, and work with medical staff to obtain pre-authorization for services. Documentation is a key aspect of this role, as the coordinator will need to document all encounters and work activities related to finding and maintaining alternate resources, updating patient electronic records, and providing monthly reports to their supervisor. The coordinator will continually research available resources, ensuring that application information is accessible to patients and that they understand the rules and regulations governing the benefits they are applying for. Additionally, the coordinator will assist with community enrollment events and participate in other community programs, fostering a collaborative and respectful work environment.

Responsibilities

• Determine eligibility of patients for direct services and alternate resources.
• Implement screening and interview methods to identify eligible patients.
• Review Purchased Referred Care (PRC) referrals and verify patient eligibility for services.
• Collaborate with facility staff to utilize alternate resources effectively.
• Develop and maintain a network of contacts in local, state, tribal, and federal agencies.
• Follow up on pending eligibility claims and assist families and agencies until application completion.
• Assist patients in appealing denials from third-party resources.
• Work with medical staff to obtain pre-authorization for services.
• Document encounters and work activities related to alternate resources.
• Research alternate resources and ensure application information is accessible to patients.
• Assist patients and families with processing applications for alternate resources.
• Interpret rules and regulations from organizations supplying benefits.
• Organize community enrollment events and participate in community programs.

Requirements

• High school diploma or equivalent.
• One year of related experience in a similar role.
• Knowledge of alternate resources regulations.
• Knowledge of various third-party payers and application processes.
• Ability to communicate clearly and effectively, both orally and in writing.
• Ability to organize multiple demands of the job.
• Skill in providing exceptional customer service.
• Skill in prioritizing and planning tasks.
• Skill in interpersonal relations and maintaining files and records.
• Ability to drive a motor vehicle in adverse weather conditions.

Nice-to-haves

• Experience with healthcare administration or patient advocacy.
• Familiarity with HIPAA regulations and patient privacy laws.
• Bilingual skills to assist a diverse patient population.

Benefits

• Health insurance coverage.
• Paid time off and holidays.
• Professional development opportunities.
• Flexible scheduling options.