Benefits Specialist

Description

ORGANIZATIONAL UNIT: Health Services Department

SUPERVISOR: Insurance & Benefits Coordinator

FLSA: Non-Exempt

PAY RANGE: $18-$22 hourly 

ALL FULL TIME POSITIONS:     In addition to your pay, your salary also includes Medical, Dental and Vision Insurance. The Biweekly deduction from employee paycheck is $40.00 for Employee Only, $95.00 Employee plus Children, $120.00 Employee plus Spouse, and $140.00 Employee plus family.  

CPN Health Services personnel may be assigned to provide services to patients of all ages including but not limited to Indian Children and will require a criminal history background screening.

JOB SUMMARY:  Responsible for assuring the identification of patients who are eligible for alternate resources. This position will assist in making applications for alternate resources such as Medicare, Medicaid, and third party eligibility with various state, federal and tribal agencies. This position works closely with the Social Security Administration to assist potential beneficiaries for Medicare, also with the County Department of Human Services and other tribal offices. This position will work closely with third party payers to coordinate benefits for insured patients. This position also works closely with CPNHS patient registration staff. Responsible for obtaining new patient demographic and insurance information prior to appointment. This position has no supervisory capacity. 

ESSENTIAL FUNCTIONS:

· Verifies current eligibility for private insurance and Medicaid patients and enters and maintains third party information in RPMS patient registration data base. Processes incoming mail regarding eligibility. Determines patient amount due when applicable, communicates closely with front desk staff to ensure proper collection of all co-pays/deductibles/private pays.

· Reviews appointment list daily to check eligibility

a. Verifies Soonercare eligibility via the online Oklahoma Health Care Authority website 

b. Verifies insurance information electronically or via telephone

c. Enters notes into patient charts or for patient registration to communicate status of resource and/or request to meet with patient to assist with application

d. Works closely with Intake staff and Insurance Specialist 

• Assist patients as needed with      understanding their private insurance, Medicaid & Medicare benefits. Responsible for coordinating patient benefit interviews to screen for SoonerCare eligibility, assist patients in applying for benefits and performs outreach activities to determine possible SoonerCare eligibility.

· Maintains filing system for eligible patients and those who do not qualify.

· Communicates frequently with third party reimbursement sources to ensure compliance with reimbursement requirements.

· Updates all patient information in RPMS system. Ensures registration and insurance data is accurate and current. 

· Responsible for scanning insurance data.

ADDITIONAL DUTIES:

· Perform other duties and projects as required by management.

MINIMUM QUALIFICATIONS FOR CONSIDERATION: 

· High School Diploma or equivalent required.

· Experience with medical terminology.

· Two (2) year’s experience in third party benefits in a medical facility.

KNOWLEDGE, SKILLS AND ABILITIES: 

· Accurate typing/data entry skills.

· Must have good organizational skills and be able to work independently.

· Computer experience required.

· Expanded knowledge of third party resources with special emphasis on Medicaid & Medicare.

· The ability to communicate effectively and accurately with providers, patients, third party reimbursement sources, and other staff.

· Required to abide by confidentiality policy.

· Knowledge of RPMS & Computer Rx systems a plus.

PHYSICAL REQUIREMENTS: 

· Prolonged sitting or standing.

· Repetitive motion at a computer.

· Light lifting, stooping, and bending will be required.

· The ability to handle a large workload with demanding deadlines.

ENVIRONMENTAL CONDITIONS: 

· Health facility office environment.

Note: The above statements are intended to describe the general nature and level of work performed by an employee in this position. These statements are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of employees in this position.