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Patient Service Representative/Health Benefit Coordinator

Company: Florida Community Health Centers
Location: Fort Pierce
Posted on: January 10, 2022

Job Description:

- - - - - -Health Benefit Coordinator - -

  • Completion of applications for state and federal programs (including Health Exchange/Marketplace programs, food stamp and prescription drug assistance programs), reviewing medical records and taking all necessary action to expedite benefit approval.
  • Interviewing patients in a community health center or hospital setting and/or at outreach events to assist the patients in obtaining maximum benefit coverage.
  • Making a determination to complete a federal, state, local or pharmaceutical benefit application based upon medical definition of disability as it relates to body systems and to functions of daily living, and information contained in medical records. - - - - - - - - - - - - - - - - - - - - -
  • Monitors and fosters ongoing communications with government agencies regarding the status of applications.
  • Effectively educates and answers inquiries from patients and family representatives regarding application process.
  • Assists callers in resolving account issues by identifying and taking appropriate actions including completing required forms to support application process -
  • Reviews inbox for daily work queues, identifies missing evidence and follows through to completion
  • Documents and updates internal database based on daily contact of select members of assigned applicant group and application evidence requirements, i.e. work activity, medical condition, third party, beneficiary, contact and demographic data financial, life and health insurance information, employment and salary verification, medical history and documentation where evidence is required.
  • Assists patients with scheduling appointments and reminding of appointments, as needed.
  • Complies with ethics, privacy and compliance policies and procedures.
  • Assists with completion of prior authorizations alongside the pharmacy team. - - - - - - - - - - -Patient Services Representative - -
    • Employee has a working knowledge of and is able to explain all aspects of the -Medical Records Policies and Procedures. (i.e., release of records, subpoenas, -etc.)
    • Greets patients as they arrive, has patient sign in, verifies demographic information and ensures ready for staff status changes. Maintains a warm and friendly environment -and exhibits good customer -service.
    • Properly works Eligibility Issues Bucket, for any insurance discrepancies the day before scheduled. Monitors next day appointment status by utilizing the automated eligibility and phone list -report.
    • Responsible party and patient demographics including address verification, are completely entered into the system in accordance with the policy and procedure manual to include name, date of birth, income, family size, alerts, PCP and contactpreference.
    • Properly identify and verify third-party coverage, sliding fee scale eligibility and complete appropriate forms (i.e., insurance verification form, income information form, Availity, Medicare questionnaire [MSP], Medicaid verifications, etc.). Obtain proof of income annually with tax return or three consecutive pay stubs. Ensure proper pay codes are -added to account including selecting proper carriers and ID numbers as required for accurate billing.
    • Understand definition of and determines migrant seasonal agricultural worker status, -homeless status, and properly enters into EHR -Systems.
    • Employee accurately explains patient responsibility for all payor codes. (i.e., -insurance, sliding fee scale, Medicaid, Medicare, and special -programs).
    • A properly executed consent for treatment and Health Care Proxy and Contact -Information Form are obtained according to -policy.
    • Maintains cash drawer ensuring accuracy and security at all times. Cash drawer consistently balances preventing shortages/overages. Ensure cash drawer is balanced upon leaving for and returning from -lunch.
    • Explains charge totals for the day and patients portion to the patients. Collects appropriate co-pays, co-insurance and sliding fee scale portions during registration and/or exiting patient. Review outstanding balances in patient -accounts.
    • Review the current days charges with -patient.
    • Review account past-due balance. (i.e., ROA, CIB, Bad debt.)
    • Process receipt for patient and keeps a signed copy of credit card -payments.
    • Timely entering of the completed encounter ensuring proper payor codes, correct site location, and diagnosis are assigned. (Encounters must be entered by noon on the 2nd business day after the date of -service.)
    • Reviews workflow dashboard, claim in hold, patient account holds, and ensures all -claims are created and resolved. Completes deposit slip, balancing cash & checks to -DCRJ.
    • Process charge entry user audit report and balances charges to encounters and -payments Daily Cash Receipt Journal (DCRJ) and compares data entry on -report.
    • Balance and complete DCRJ accurately and completely.
    • Ensure all receipts are accounted for and used in sequential -order. -Minimum Qualifications
      • High School Diploma or its equivalent with five years of experience, -in the above-mentioned categories may be substituted for the requirededucation.
      • Valid Florida Drivers License and has reliable/accessible -transportation.
      • Bilingual -Spanish/English Preferred
      • Must complete required CMS Certified Application Counselor (CAC) Training -and receive passing -score.
      • Must maintain Certification as CAC, as a condition of -employment.
      • Must have knowledge of community resources
      • Data Entry/Medical Office Experience preferred. -Skills and abilities
        • Must exemplify a professional -demeanor.
        • Possess empathy with the target population and must be culturally sensitive to -all racial/ethnic groups.
        • Ability to communicate effectively verbally and in writing in -English.
        • Ability to establish and maintain effective working relationships with -others.
        • Must be a -self-starter.
        • Ability to work independent of constant -supervision.
        • Ability to prepare and maintain records and -reports.
        • Must be prepared to report suspected child or elderly abuse as well as suspected fraud -to the appropriate -authorities.
        • Be computer -literate.
        • Be able to work with clients who may be unable to read, write and are unable to operate -a computer.
        • Must be able to prioritize work, and be flexible to changes at any -moment.
        • HIV education and prevention experience, a plus
        • -Additional NotesThis job description is not intended to be all-inclusive, and employee will also perform other reasonable related business duties as assigned by supervisor.Required qualifications:
          • Legally authorized to work in the United StatesPreferred qualifications:
            • 18 years or older

Keywords: Florida Community Health Centers, Fort Pierce , Patient Service Representative/Health Benefit Coordinator, Other , Fort Pierce, Florida

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