Patient Benefits Clerk- Regular

GOALS FOR THIS POSITION:

Provide prompt and courteous patient service.

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.

• 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.

This job has no supervisory responsibilities.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative…