Responsible for conducting eligibility screenings, assessment of patient financial requirements, and counseling patients on insurance benefits and co-payments. Identifies patients who are eligible for alternative resources and serves as a liaison between the patient, hospital, and governmental agencies.

Ensures applicable federal, state, local and organizational privacy laws and regulations are followed with issues related to Health information, confidentiality, the release of information, and patient rights. Assures maximal identification of persons who have, and/or eligible for alternate resources, by implementing screening and interviewing methods. Works with patient registration/receptionist, social services, and other disciplines that may assist in developing registers of eligible patients through their current activities. Evaluates patients for existing insurance coverage, federal and state assistance programs, or charity applications. Provides leadership and acts as an advocate for Indian patients in the effective utilization of alternate resources such as Medicare, Medicaid, Department of Veterans Affairs (DVA), Third Party Liability, Sooner Care, Advantage Waiver, and other resources. Works closely with all facility staff in the identification and utilization of all alternate resources available to the Indian population served. Assists families and individuals in an application for, and use of alternate resources. Visits with patients to finalize documents necessary for assistance approval. Obtains legally relevant medical evidence, physician statements, and all other documentation required for eligibility determination. Submits patient's applications accurately online and to the separate governmental agencies, follows application status to completion and updates account with the verified third party information. Provides benefit information and interprets rules and regulations. Establishes eligibility of potential Medicare eligible by working with the Social Security Administration (SSA), on local and regional levels. Works closely with local Department of Human Services and Tribal offices to establish eligibility for Medicare, Temporary Aid for Needy Families (TANF), and Supplemental Security Income (SSI). Verifies eligibility by contacting the nearest Social Security Administration (SSA) or State Department of Human Services (DHS) or Oklahoma Health Care Authority (OHCA) to verify the eligibility of patients. Interviews all patients eligible for Medicare and Medicaid benefits to ensure they understand their entitlements in IHS and tribal facilities. Follows up on all pending eligibility claims and addresses any concerns of patients. Initiates and maintains proper follow-up with patient and governmental agency caseworkers to ensure timely processing and completion of all mandated applications and accompanying documentation to ensure renewed program eligibility. May be required to complete applications for eligibility of service; including securing and reviewing backup documentation, computing income, and determining hours of care for which client is eligible and may issue proper documents to clients for eligibility continuation. Verifies information for accuracy and completeness against existing records and ensures appropriate signatures are obtained on all necessary forms. Enters information in the Resource Patient Management System (RPMS). Files and retrieves records in accordance with established procedures and filing systems. Researches lost or missing applications or records in accordance with established procedures. Maintains knowledge of current information privacy laws and issues related to health information, the release of information, and patient rights. Other duties may be assigned.

SUPERVISORY RESPONSIBILITIES

This job has no supervisory responsibilities.

EDUCATIONAL REQUIREMENT

Associate's degree from a 2-year college or technical school in Social Services or Health-related field; or three years related experience; or equivalent combination of education and experience. May include two years or more of undergraduate college coursework.

EXPERIENCE REQUIREMENTS

An additional one (1) year of experience in a related field.

COMPUTER SKILLS

An individual should know Spreadsheet software and Word Processing software.

CERTIFICATES, LICENSES, REGISTRATIONS

Must possess a valid driver's license with a driving history verified through a motor vehicle report that meets requirements for Cherokee Nation underwriting rating. Must obtain ACA Marketplace CSC Certification within one (1) year of hire and maintain throughout employment.

OTHER QUALIFICATIONS

Employee must not and will not be under sanction by the United States Department of Health and Human Services Office of the Inspector General (OIG) or by the General Services Administration (GSA) or listed on the OIG’s Cumulative Sanction Report, or the GSA’s List of Excluded Providers, or listed on the OIG’s List of Excluded Individuals/Entities (LEIE). Must demonstrate proficiency in OHCA Enrollments within three (3) months of hire.

PHYSICAL DEMANDS

While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is occasionally required to stand and walk. The employee must frequently lift and/or move up to ten (10) pounds.

WORK ENVIRONMENT

The employee may occasionally be exposed to outdoor weather conditions. The noise level in the work environment is usually moderate.