Maniilaq Association

01/16

Title:  Alternate Resource Specialist I/ II                                                                                               Range:  12/13

Program:  Patient Financial Services                                                                                                     Status:  Non-Exempt

Housing Priority: None                                                                                                                        Covered:  No

POSITION SUMMARY:

The purpose of this position is to seek out, identify, and encourage eligible patients and community members to obtain benefits that may offset some or all of the costs associated with the patient’s treatment. This position identifies and informs patients of eligibility of programs and/or benefits, verifies and assists in completion of claim forms and benefit applications. This position verifies daily inpatients and notifies UR and/or Case Manager in order that they may obtain timely pre-certifications/pre-authorizations. This position assists residents in local and village benefit enrollment projects, submits applications, travel requisitions, other appropriate paperwork within 48 hours of receipt and/or meets deadlines. This position updates, maintains, and keys eligibility lists on a monthly basis. This position submits documentation on newborns weekly to appropriate agencies. Reports directly to the Alternate Resources Supervisor.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

1.       Identifies patients and community members who may be eligible for alternate health benefit resources of other programs where eligibility for that program may in turn qualify the patient for alternate health benefit resource funding.

2.       Works with the patient and/or community member to identify which alternate benefit resources may be applicable, based on knowledge of the eligibility criteria for the various programs.

3.       Assists patients or other responsible person(s) in determining eligibility for a variety of programs, e.g., Medicaid (with an emphasis on the Alaska Children’s Health Insurance Program), Medicare, VA, private insurance, and submits weekly documentation on newborns. Assists the Medicaid Specialist and Biller to ensure clean claims submitted first time, due to program information updates.

4.       Works with others who may be aware of the patient’s situation of eligibility for benefits, e.g., village representatives, employers, private insurance companies, etc., if the patient needs assistance in this process.

5.       Must utilize skill in eliciting sensitive information from patients and community members regarding personal relationship, finances, family history, etc.

6.       Assists the patient in the application or appeal process to determined benefit eligibility.

7.       Submits the required forms and documentation to the proper agencies within required deadlines and follows up.

8.       Obtains additional information from the patient or others as needed to avoid delays in the processing of the claim.

9.       Ensures procedural compliance of the alternate health resource information gathering process and the primary payer requirements of Federal Regulations.

10.    Maintains communication and a cooperative relationship with various Federal, State, Municipal, Civic, Native and other service organizations to obtain and use resources of referred patients.

11.    Initiates and assists patients with the appeals process if the initial application is denied for patients that appear to be eligible for benefits.

12.    Maintains records of eligibility data for each patient and maintains complete documentation to ensure the use of the Express Application system.

13.    Advises and assists patient registration especially in regard to verifying eligibility requirements for Medicaid, Medicare, VA, insurance companies and other alternate health benefit resources.

14.    Travels frequently for training and in small planes to villages and by snow machine and other non-traditional means to canvas communities and participate in enrollment projects for eligible parties.

15.    Establishes a routine program for patient education and regular Public Service Announcements to achieve targeted goal.

16.    Resource Specialist II must maintain the program budget and make sure grant guidelines are followed.

17.    Performs patient registration assuring all information is current in the RPMS system.

18.    Performs other duties as assigned as needed by program.

MINIMUM REQUIREMENTS:

Alternate Resource Specialist I:

High School Diploma or equivalent required.  Requires one year’s relevant experience. Prefer six months’ registration experience. Must be able to type well enough to accomplish job duties.  Basic Microsoft Word and Excel experience required. Inupiaq speaking ability is preferred.  Must be able to communicate orally and present presentations to explain various program requirements to patients, whether individuals or groups. RPMS experience preferred but not required.  Must be able to do public service announcements.  Must be able to travel overnight to villages in small planes.  Ability to lift 40 pounds.  Ability to effectively communicate and work well with others.

Alternate Resource Specialist II:

Must meet all of the above qualifications of the Benefit Resource Specialist I.  Requires additional two years of relevant work experience. Must demonstrate proficiency in knowledge of Medicaid, Medicare, VA, DKC, and third party payor State and Federal rules and regulations. Must be able to work with minimum or no supervision.  Must be able to maintain program budget and an understanding of grant guidelines.

DISCLAIMER

The above statements are intended to describe the general nature and level of work being performed by people assigned to this job.  They are not intended to be an exhaustive list of all responsibilities, duties and skills required of people in this job.