Job Title: Patient Benefits Clerk
Department: Patient Benefits
Reports To: Patient Benefits Manager
Salary Level: $38,521-$49,795
FLSA Status: Non-exempt
Approved By: Chief Executive Officer
Approved Date: July 2022
GOALS FOR THIS POSITION: Provide prompt and courteous patient service.
SUMMARY:
Provides the highest level possible of customer service standards in patient check-in process, answering calls, scheduling appointments; identify patients for eligibility for alternate resources, and assisting patients with any other needs. Greets and ascertains client’s primary demographic information and verifies form of payment prior to scheduling appointment or checking into the clinic to insure maximum reimbursement to K’ima:w Medical Center.
FUNCTIONS & RESPONSIBILITIES:
- Greets and interviews clients to obtain and record all required information in the facility computer data base.
- Works closely with facility staff to identify all alternate resources available, assist clients in application for use of alternate resources.
- Assist patients in establishing and verifying eligibility for alternate resources and must work closely with the local and regional Social Security Administration office, Tribal Offices, Department of Social Services, State Medical Assistance Office, and other appropriate agencies.
- Independently determines patient eligibility for Medicare, California State Medicaid, Department of Veterans Affairs, Third Party Liability, Workmen’s Compensation, Private Insurance, CHDP Gateway, Covered California, BCCTP, Presumptive eligibility and any other applicable resources.
- Contacts alternate agencies through telephone, correspondence and personal visits to ensure maximum utilization.
- Conducts personal interviews with client and/or family member to determine potential eligibility for any alternate resources and assists with the application and follow through until completion.
- Follows up on all pending applications and works closely with families and agencies so that the patients are not discriminated against as well as performs a variety of patient representative functions including completions of application for alternate resources, social security, in-home support services, etc.
- Enter the Provider schedule based on information received from Medical Secretary into BPRM.
- Check in patients using the BPRM
- Enroll patient on a panel for a specific provider and/or add them to the team panel if not already done.
- Maintain demographic information (address, home, work, cell numbers, e-mail etc.)
- Collect and scan insurance cards and forms from the patient into the Vista Imaging system.
- Obtain pertinent medical information before the patient is seen (medical records, referrals, ancillary results)
- Process various forms such as, Workman’s Compensation, Employee Physicals, WIC, CHDP etc. as needed.
- Refer patients to proper department as needed.
- Ensure that patient care and management activities are performed with the utmost attention to patient confidentiality and HIPAA.
- Arrange transportation for patients to medical appointments, if needed.
- Register new patients and inactivate/activate patients as needed in BPRM
- Update patient information into BPRM
- Send pre-appointment letters a week before their scheduled appointment.
- Notify patient of appointment the day before appointment, asking the patient to come 15 minutes early for the appointment and addressing what needs to be brought to appointment, i.e. insurance documents, medication bottles, etc.
- Prepping providers schedules the day prior to the appointment; insuring all forms needed for that appointment are completed and ready when the patient arrives.
- Assist patients in filling out the Release of Information and Consent forms as needed.
- Participate in the Improved Patient Care models and participate on the Care Teams as needed.
- Comply with ongoing participation in Joint Commission activities, including trainings and meetings.
- Retrieve and log incoming and outgoing faxes and distribute to the proper care team.
- Collect co-payments and clinic costs from the patient completing receipts and delivering payment to the Fiscal Department.
- Other duties as assigned.
SUPERVISORY RESPONSIBILITIES: This job has no supervisory responsibilities.
QUALIFICATIONS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable with disabilities to perform the essential functions.
BASIC REQUIRED ABILITY:
JOINT COMMISSION RESPONSIBILITIES: Responsible for helping to prepare, achieve, and maintain accreditation by the Joint Commission on Accreditation of Healthcare Organizations. By serving on the various performance improvement subcommittees individual employees are directly involved in the generation or modification of policies & procedures that enable KMC to provide continuously improving healthcare.
PUBLIC RELATIONS/ADVANCED INTERPERSONAL SKILLS: Addresses clients by name; smiles when talking to clients, physicians. Peers, and families; answers the telephone courteously and promptly; identifies self and department when answering the telephone using pleasant voice tone/verbiage; possesses excellent listening skills; interacts with clients and peers.
COOPERATION: Must be a self-starter; seeks solutions; accepts constructive criticism; willing to adjust to changes; loyal to K’ima:w Medical Center.
PROFESSIONALISM: Shows pride in personal appearance and grooming; displays a positive attitude about work; respects the confidentiality of clients; and is congenial with public and peers.
INITIATIVE: Willing to participate in continuing education programs; asks questions; contributes during staff meetings; serves on K’ima:w Medical Center committees as appointed, demonstrates a desire for self improvement.
JOB SPECIFIC SKILLS & ABILITIES:
- Demonstrate ability to perform processes in the delivery of care to specific age groups.
- Demonstrate skill in operation of computer, calculator, and other office equipment.
- Demonstrate ability to work independently, establish priorities and meet deadlines.
- Demonstrate knowledge of maintaining and managing files and records.
- Must be able to type a minimum of 45 wpm.
- Demonstrate the ability to work with in a team setting; coordinating care and communicate with others on the staff is critical.
EDUCATION and/or EXPERIENCE:
- High School Diploma or equivalent G.E.D.
- One to two years related experience and/or training or equivalent combination of education and experience preferred but not required.
- Knowledge of RPMS, BPRM, and IHS-EHR or a data base computer system preferred but not required.
CERTIFICATES, LICENSES, REGISTRATIONS:
Current CPR Certificate
Valid California Drivers License
LANGUAGE SKILLS:
Ability to read an comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization. Demonstrated knowledge of grammar, spelling, punctuation and common technology.
REASONING ABILITY:
Ability to add and subtract two digit numbers and to multiply and divide with 10's and 100's. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
CONFIDENTIALITY:
Employee must be aware of and adhere to K’ima:w Medical Center’s Confidentiality Policy and deal appropriately with patient confidentiality at all times.
CONDITIONS OF EMPLOYMENT:
Employee is subject to baseline and random drug testing per the Hoopa Tribal Drug & Alcohol Fit for Duty Policy. Employee will serve a 90-day introductory period. Employee is subject to introductory and semiannual performance evaluations. Preference will be given to qualified Indian applicants pursuant to the Tribe’s TERO Ordinance.
PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
WORK ENVIRONMENT:
The work environment characteristics described here are representative of those and employee encounters while performing the essential functions of this job. Reasonable accommodations may be make to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is occasionally exposed to blood borne pathogens, airborne formites, infections, and other contagious diseases and outside weather conditions. The noise level in the work environment is usually moderate.
ANNUAL TRAINING REQUIREMENTS:
At a minimum Employee is required to be certified for the following training:
KMC Annual Orientation, to include infection control, safety, & personnel policies, etc.
CPR every two years.
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Employee Signature Date
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Supervisor Signature Date
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Human Resources Director Date