Coordination of Benefits Analyst- PRC

The primary purpose of this position is to identify tribal members with eligibility for alternate resources, assisting them with the enrollment process, act as an advocate and liaison in the effective utilization of alternate resources. This position seeks to increase the education, outreach, and enrollment of tribal members in a variety of federal, state, local, tribal health, social services, and veterans programs.

This position motivates a collaborative effort of benefits coordination as a working component of the Purchased Referred Care Services. This includes case file review and updates/training as necessary for quality assurance of services provided and maintaining current information from and/all proposed alternate resources. Work in collaboration with the Clinic Applications Coordinator to maintain a minimum requirement of knowledge specific to RPMS/CHS Patient Registration.

This position will assist with the administering the Purchased Referred Care (PRC) Services benefits and authorization for services based on severity, need and availability of funds.

• Associate's Degree in Business Administration, Social Work, Health Administration or related field required.
• Must have direct experience and demonstrated proficiency working with Medicare Part A, B & D, Medicaid, SSI, VA, and other medical billing.
• Must have a valid unrestricted driver license and be insurable by the GTB insurance carrier.

• Works closely with facility staff to identify all alternate resources available. Assists tribal members in application for use of alternate resources, and establishing and verifying eligibility for alternate resources.
• Responsible for working closely with local and regional Social Security Office, Tribal Offices, Community Department of Welfare, Human Services, Department of Social Services, State Medical Assistance Office and other appropriate agencies.
• Examines alternate resources available to patients under the Grand Traverse Band's Purchased Referred Care Services Program. Determines tribal members eligibility for Medicare, Medicaid, Department of Veterans Affairs, Worker's Compensation, private insurance, state programs, and any other applicable resources. This requires the application of Purchased Referred Care Services rules to determine eligibility.
• Builds and maintains close working relationships with agencies administering benefits to ensure maximum utilization, including contact through telephone, correspondence, and personal visits.
• Conducts personal interviews with tribal member and/or family member to determine potential eligibility for any alternate resources, as necessary.
• Provides and maintains up to date information with materials, enrollment forms, and information brochures regarding benefit programs, such as Medicaid, Medicare, Veterans, SSA, etc., and their eligibility requirements.
• Serves as a liaison and follows up on all pending applications, and works closely with families and agencies, intervening on patient's behalf in disputing and debating denials. Performs a variety of patient representative functions including completion of applications for alternate resources, making home/hospital visits to interview patients, arrangement for transportation, as necessary.
• Coordinates with organization's Elder, nutrition, health, and other social service programs to provide outreach to Elders on benefits for which they are eligible. Makes presentations at organizational events such as Elder Advisory Council Meetings and community gatherings. Prepares and submits information articles to Tribal and organizational newsletters.
• Assists tribal members and Elders with all benefits matters, including explaining policies and competing enrollment forms for various federal and state social service programs.
• Responsible for submitting and tracking completed forms to federal and state social service programs. Coordinates with other GTB staff and with tribal members to ensure that patient completes application in a timely manner.
• Investigates, analyzes and resolves a wide range of benefit issues, which include documentation of the steps taken in…