Job Title: Patient Benefits Manager
Department: Revenue Cycle/Fiscal
Reports To: Revenue Cycle Manager
Salary Level: $50,924 - $66,747 Annually
FLSA Status: Non-Exempt
Approved By: Chief Executive Officer
Approved Date: April 19, 2022
SUMMARY:The primary function of this position is to provide leadership to the Patient Benefits staff while managing the daily operations of the department and front-end revenue cycle functions. This includes demographic and insurance data collections, patient registration, identifying patients with eligibility for alternate resources, assisting them with the enrollment process, acts as an advocate for Indian patients in the effective utilization of alternate resources, and assists clients with other social service needs. The Patient Benefits Manager will promote exceptional patient experiences by demonstrating high quality and professional level of service at all times and educates staff to achieve K’ima:w Medical Center standards.
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, state programs, 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.
- Performs a variety of patient representative functions including completions of application for alternate resources, social security, in-home support services, etc.
- Insure input of monthly calendar in BPRM Scheduling module.
- Administer Tribal assistance programs such as Emergency Assistance, LIHEAP, and the Elders Kerosene Program.
- Other duties as assigned.
SUPERVISORY RESPONSIBILITIES:
Directly supervises employees in the Patient Benefits/Front Desk Department including Greeters and carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. addressing complaints, resolving problems as well as develops job descriptions and performance criteria for staff.
Oversees the responsibilities related to the daily workflow of the Patient Benefits department and assigns and directs job responsibilities.
Analyze and utilize the data from various reports including but not limited to daily, weekly, and monthly departmental reports, to coordinate workflow and processes to ensure optimal functionality within the department.
Ensures processes are established and followed concerning patient registration and check-in to minimize loss of revenues.
Must submit written goals and objectives long term and short term for each fiscal year to correspond to the annual budget preparation and must be submitted to the Revenue Cycle Manager no later than May 1 of each year. Goals and Objectives should be consistent with organization wide goals and objective; GPRA, State Review, HIPPA, the Indian Health Service RPMS survey, and Joint Commission survey preparation and compliance.
Must submit written budget and capital budget for each fiscal year by May 1 of each year and must submit these including narratives for each line item to the Executive Secretary.
Conducts annual performance reviews for department staff. Ensures job descriptions accurately reflect current job responsibilities, oversees the hiring process, and also the employee recognition and disciplinary functions for department staff.
Must provide department specific orientation to all new staff during the first day of work, orientation must address all aspects of Environment of Care. A signature sheet for documentation shall be completed.
Must be responsible to make certain all staff are in compliance with CPR requirement, TB testing and immunization and any required certification.
Must provide monthly staff meetings for Department specific staff and appropriate minutes of meetings must be kept.
Address complaints and resolves problems with staff, patients, and all other complaints from community members or visitors that should arise within the department.
Must participate in appropriate committees; Revenue Cycle Administrative & Revenue Cycle Meetings, Morning Report, Managers Meetings, and Staff Meetings.
At the end of each calendar year must submit an annual report to the Revenue Cycle Manager no later than January 30.
Must provide staff audits of department work, with documentation of deficiencies and corrections.
Must provide customer satisfaction surveys if applicable.
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
Must have the ability to perform processes in the delivery of care to specific age groups.
Must have skills in operation of computer, calculator, and other office equipment.
Must be able to work independently, establish priorities and meet deadlines.
Demonstrated knowledge of maintaining and managing files and records.
Must be able to type a minimum of 45 wpm.
EDUCATION and/or EXPERIENCE
High School Diploma or equivalent G.E.D.
Bachelor’s Degree preferred or 3-5 years of related experience and/or training in a Patient Access department required.
Minimum of six (6) months experience in BPRM, RPMS, IHS-EHR and/or other data base computer systems required.
Minimum of two (2) years of experience working with health insurance companies such as Partnership Health Plan, California State Medicaid, Private Insurance, Medicare, Veteran’s Administration, and SSI/SSD required.
Minimum of two (2) years of supervisor experience preferred.
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 (2) two years.
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Employee Signature Date
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Supervisor Signature Date
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Human Resources Director Date