|Program:||Health Center||Salary Grade:||GS – 10|
|Supervisor:||Associate Director-Business Services||Salary Range:||$16.24-$19.39|
|FLSA Status:||Exempt Non-Exempt Public Safety||Position Type:||Regular Full-Time|
Identifies Medicaid, Medicare Parts B,C & D, qualified health plan eligibility by gathering information, interviewing clients, family or authorized representatives, and obtaining collateral sources. Identifies and communicates with certified service providers to channel and coordinate placement of clients/family with the appropriate services; assists with the identification and certification of new service providers; and provides technical assistance. Maintains accurate records of referrals identified for eligibility certification, timeliness of paper processing and eligibility approval; prepares reports of demographics and outcome measures; and reviews overall process and makes recommendations for optimum productivity, assists families with the re-enrollment of financial support once clients are discharged from federal and state programs. Creates and maintains database for retrieval of pertinent information.
ESSENTIAL DUTIES & RESPONSIBILITIES
- Interview patients at the time of service in order to determine available or accessible resources for which the patient is eligible. Assists patients with interpretation of rules and regulations to alternate resources.
- Remain current on Medicare guidelines and memos from Centers for Medicare and Medicaid Services/Health Plan Management System (CMS/HPMS) to ensure compliance with all correspondence, enrollments, grievances, Late Enrollment Penalty (LEP) and COB guidance.
- Review and process all enrollment applications for Medicare Part D in a timely manner, verifying CMS eligibility and validating enrollment reasons and all member-related data. Complete data entry and miscellaneous card and file production tasks related to Medicare Part D.
- Process Medicare & Medicaid member updates and check daily file to ensure updates are approved.
- Ensures that all program applications submitted to Department of Health, Welfare and Social Services, and other Nevada state based agencies are complete with supporting documentation needed to make an eligibility determination.
- Inputs and updates data in the eligibility determination system and the RPMS system when changes occur.
- Process Medicaid applications and recertification’s for potential members through the local district or the Federal Exchange/Marketplace.
- The Benefits Coordinator/Patient Registration Clerk is required to screen and assist all patients, insured or uninsured in applying for the appropriate government programs. Assists patients in completing the necessary applications, explaining what documentation is required for a complete application. Screens all in-house and outpatient admissions to identify financial lapse of insurance. Ability to explain to patients their paperwork received from federal and state agencies and trouble shoot the issues. Follows up on all submitted applications, assuring compliance and acts as a liaison between patients, clinic staff and government agencies in an effort to obtain approvals in a timely manner.
- Assists in making and/or coordinating arrangements with or for the patient in order to complete the required application process for alternate resources.
- Establishes a working liaison with the alternate resource agencies (e.g. – Social Services, Tribal Offices, Social Security, etc.) for the purpose of certifying patient eligibility, providing contact for patient interaction and to obtain knowledge of current rules/regulations.
- Works closely with the Contract Health Services (CHS) office to provide patient alternate resource eligibility and/or enrollment information.
- Receives on-going training and maintains current knowledge and expertise in the area of alternate resources, CHS processing, and eligibility information.
- Maintains accurate files on all pending claims and works closely with families and agencies to see that the patient is not discriminated against.
- Assumes adherence to the Federal Privacy Act, HIPAA and Freedom of Information Act.
- All patients must be registered in the RPMS (Resource and Patient Management System) Patient Registration application before care is rendered; with the exception of emergency services. On subsequent encounters, each patient’s demographic and third party information must be updated.
- Interview Health Center patients to obtain and process demographic and insurance information for patient registration, contract care and the Health Center computerized billing systems.
- Updates Patient Registration in the EMR (Electronic Medical Record) System on each patient visit; works closely with Medical Records, Dental, Optometry, Psychology and the Billing Office to provide them with updated information.
- Advises the receptionist to redirect walk-in patients back to patient registration.
- Performs other job related duties as assigned by the supervisor
KNOWLEDGE, SKILLS & ABILITIES
- Good communication skills, both verbal and written.
- Familiarity with computers, demonstrated by two or more computer courses or at least one-year work experience.
- Practical knowledge of Medicare, Medicaid, Contract Health Services (CHS), EVE’s system and third-party reimbursement procedures and medical terminology.
(To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions)
- Candidate must have a High School Diploma or GED certified.
- Must have Exchange Enrollment Facilitator (EEF) certification or obtain within six (6) months from date of hire.
- At least one year’s experience in a medical office (either in-patient or out-patient) facility is preferred.
PLEASE COMPLETE AN APPLICATION AT FPST.ORG/EMPLOYMENT/ TO APPLY.
POSITION CLOSES ON OCTOBER 24, 2021 AT 5:00 P.M.