Patient Benefits Coordinator

Job Details

TOHAJIILEE, NM

Full Time

High School

Day

Description

Department:

Patient Services

Reports To (Title):

Patient Services Manager

Job Code:

Classification:

Non-Exempt

Pay Range:

Effective Date:

February 04, 2022

Hours/Week:

40 hours

Revised Date:

April 21, 2025

Position Type:

Full-Time

PERFORMANCE EXPECTATIONS

In performance of their respective tasks and duties all employees of the Canoncito Band of Navajos Health Center Inc. (CBNHC) are expected to conform to the following:

Uphold all principles of confidentiality and patient care to the fullest extent.

Adhere to all professional and ethical behavior standards of the healthcare industry.

Interact in an honest, trustworthy and dependable manner with patients, employees and vendors.

Possess cultural awareness and sensitivity.

Maintain a current insurable driver’s license.

Comply with all CBNHC policies and procedures, as well as all applicable laws.

POSITION PURPOSE

This position will offer a range of financial services to patients and families in accordance with guidelines. Interview patients regarding financial status and assist families and individuals in applying for alternative medical resources in accordance with federal and state guidelines.

ESSENTIAL DUTIES, FUNCTIONS AND RESPONSIBILITIES

Identifies and qualifies patients for healthcare benefits and alternate resources.

Works as a liaison between the community and Medicare, Medicaid, Veterans Administration, New Mexico Health Insurance Exchange providers, medical services, private insurances, SSI, SSDI, State programs and other applicable resources.

Develops effective screening and interviewing methods to assure maximum identification of individuals who may be eligible for alternate resources.

Conducts personal interviews with patients and/or family members to gather and research personal and sensitive patient information. Compiles information to determine benefits. This may include making home visits to follow up on incomplete applications.

Serves as a patient advocate and in partnership with community members in obtaining alternate resources and healthcare benefits.

Provides community outreach and education on alternate resources to patients.

Monitors eligibility of benefits for qualified patients to minimize breaks in coverage.

Assists healthcare and other professional staff members in understanding elements and requirements of Social Security Administration/Disability Determination on Services and how to best help individuals with disabilities to obtain benefits.

Updates Patient Benefits information and 3rd party benefits information.

Tracks assistance applications; compiles and distributes information regarding patient personal insurance and financial status; provides appropriate forms to billing and other departments.

Collaborates with other departments such as Patient Registration, Medical Records, Billing, and Purchase Referred Care to update patient application and information.

Obtains documentation from patients to establish eligibility for services. Maintains sufficient records, authorizations or clinic information, eligibility forms and standard forms and explain patient’s rights under the Privacy Act and HIPAA guidelines.

Works with Purchase Referred Care in determining patient eligibility for care under the PRC.

Researches and identifies alternate resources available to patients, while ensuring superior, quality care of the patient(s).

Provides support to Patient Registration, Medical Records and Purchase Referred Care personnel.

Enhances professional growth and development through participation in educational programs, meetings, and workshops as assigned or appropriate.

Compiles and provides written monthly reports.

Follows departmental policies, procedures, and objectives, continuous quality improvement objectives, and safety, environmental, and/or infection control standards.

Provides information to patients and community on current changes and updates of all resources and guidelines for eligibility of patients.

Completes required certification training (Presumptive Eligibility Determiner) to gain access to assist patients with Medicaid eligibility.

Performs other duties as assigned.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the primary functions of this job. Normal office conditions exist, and the noise level in the work environment can vary from low to moderate. Limited overnight travel may be required from time to time. This position may be exposed to certain health risks that are inherent when working within a health center facility.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the primary functions of this job. While performing the duties of this job, the employee may be required to frequently stand, walk, sit, bend, twist, talk and hear. There may be prolonged periods of sitting, keyboarding, reading, as well as driving or riding in transport vehicles. The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include reading, distance, computer, and color vision. Taking and hearing are essential to communicate with patients, vendors and staff.

Mental Demands

There are a number of deadlines associated with this position. The employee must also multi-task and interact with a wider variety of people on various and, at times, complicated issues.

OTHER

All employees must uphold all principles of confidentiality, HIPAA and patients care to the fullest extent. This position has access to sensitive information and a breach of these principles will be grounds for immediate termination.

Disclaimer: The information on this position description has been designed to indicate the general nature and level of work performance by employees in this position. It is not designed to contain, or be interpreted as, a comprehensive inventory of all duties, responsibilities and qualification required of employees assigned to this position. Employees will be asked to perform other duties as needed.

Canoncito Band of Navajos Health Center Inc. is a Navajo Preference Employer. As required by the Navajo Preference in Employment Act, preference will be given to qualified Navajo applicants. If there is no qualified Navajo applicant, preference will be given to qualified American Indian applicants consistent with the Indian Self-Determination Act Indian preference provision.

Qualifications

MINIMUM MANDATORY QUALIFICATIONS

Experience

Two (2) years of similar or related experience in a healthcare setting.

Education

High School Diploma

Mandatory Knowledge, Skills, Abilities and Other Qualifications

Must be able to carry out the essential duties, functions and responsibilities.

Knowledge of applicable federal, state, county and local laws, regulations and requirements.

Knowledge of medical insurance claims procedures and documentation.

Knowledge of the precertification requirements, procedures and documentation of third-party medical insurance payors.

Ability to gather data, compile information, and prepare and maintain written records and reports.

Strong working knowledge of computers and software applications.

Knowledge of Medicaid, Medicare, Social Security, Tribal, and Department of Human Services and private health insurance.

Knowledge of a body of standardized rules, procedures, or operation that require considerable training and experience to perform the full range for a Patient Benefits Coordinator and resolve recurring problems.

Excellent knowledge of a healthcare setting.

A team player with excellent communication and interpersonal skills.

Ability to communicate clearly and effectively with patients and other external parties in a courteous and friendly manner at all times.

Must be able to maintain confidentiality at all times.

Ability to perform other duties as assigned.

PREFERRED QUALIFICATIONS

Bilingual skills in English and the Navajo language.

Bachelor’s degree in Business Administration.

Three to five years of clinical setting or equivalent experience as a Patients Benefits Coordinator.