Job Purpose & Position Overview:
The primary purpose of this position is to function as the Patient Benefits Coordinator (PBC); assuring the identification of patients whom are eligible for any third party resources, that the patient meet eligibility criteria, including demographics and financial guidelines for the programs to apply for. Will be responsible for assisting patients with applications, paper or preferably online in a real time application. Make internal referral to Public Health Nursing (PHN) for home/hospital visits on any request or an as needed basis for care. This referral can be either telephone or email and with the documentation of services in patient’s health record.
Responsible for providing internal referral to Community Healthcare Representative (CHR), Public Health Nursing, or Public Transit system for the transportation needs for patients. Will interpret rules and regulations for alternate resources to patients. If the patient does not meet any eligibility criteria, for third party resources, it shall be the responsibility of the PBC to print and scan the denial letter in the patients’ health record.
Specific Job Duties/Responsibilities:
- Act as an advocate for American Indian patients in securing alternate resources, such as Medicare, Medicaid, State Children’s Health Insurance Plan, Workman’s Compensation, Third Party Liability, Department of Veterans Affairs, Market Place Insurance, ACA Obama Care Insurance, Children’s Special Health Services, etc.
- When a patient is identified as needing to apply for insurance, the PBC will assess what the patient may be eligible to apply. If time allows, the PBC will apply online via computer or telephone to the appropriate agency. Once submitted, the PBC clerk will print out the result of the application—approved, pending, or denied and scan into the patient’s health record and document accordingly in RPMS. This insurance verification process will be reviewed prior to the patient’s outside referral going to PRC Committee.
- The PBC will identify a person who has no insurance and may be eligible for alternate resources by utilizing screening and interviewing methods effectively. Works closely with all facility staff in the identification and utilization of all alternate resources available to the American Indian population.
- Works closely with the Social Security Administration (SSA) on local and regional levels, local DHHS offices, all tribal offices to establish eligibility of insurance for patient needs. The PBC will set appointment times for the telephone interviews for the patient and schedule for the patient to be onsite if necessary. The PBC will set up transportation for the patient to come into the facility if needed for the telephone interview, etc.
- After patient check-in at patient registration, a referral may be made to the PBC for Third Party eligibility. PBC will work with social services and all other disciplines to ensure the patient’s needs are met. PBC will keep a register of eligible patient’s health status of the elderly and assist individuals with applications for alternate resources, providing internal referrals for transportation, making calls to CHR, PHN or Public transit for transportation, and interpretation of rules and regulations. Works closely with families, individuals, and agencies to ensure the patient does not encounter discrimination because of their dual role as a citizen and as an Indian Health Care recipient.
- If the patient has Medicare, Medicaid, Private Insurance or any other type of insurance coverage, the PBC will ask for the patient’s card. The patient’s card will be copied and scanned into the patient’s Electronic Health Record. PBC will verify the insurance card: The account number, effective date, term, and ending dates, if any, before a referral for an outside provider goes to PRC Committee for approval. The patient shall be informed
that not having the copy of the card in their chart can cause a delay in the referral process.
- If a patient does not comply and provide the facility with a copy of their Medicare, Medicaid or Private Insurance card, the patient will sign a waiver that they are willingly non-compliant with the rules and regulations of the facility and will be responsible for the cost of their visit.
- The PBC bi-weekly schedule will allow for one day only to schedule all out of office transports. This will allow the patients with no transportation to follow-up with SSD face-to-face interviews on the bi-weekly schedule. PBC will enter every transport in the patient health record.
- Other duties as assigned.
