Coordination of Benefits Analyst- PRC
On-siteSuttons Bay, Michigan, United States
Job Summary
Identify tribal members eligible for alternate resources and assist them with enrollment in federal, state, local, tribal health, social services, and veterans programs. Act as an advocate and liaison to maximize utilization of Purchased Referred Care Services by reviewing case files, verifying eligibility for Medicare, Medicaid, VA, and other resources, and resolving benefit denials. Conduct personal interviews with patients and families, make home visits, and coordinate with agencies including Social Security and Tribal Offices to ensure timely application completion. Maintain up-to-date knowledge of program rules, provide regular training, and participate in quality improvement meetings while collaborating with clinic staff and health providers across the six-county service area.
Required Qualifications
- Associate's Degree in Business Administration, Social Work, Health Administration or related field
- Direct experience and demonstrated proficiency working with Medicare Part A, B & D, Medicaid, SSI, VA, and other medical billing
- Valid unrestricted driver license
- Insurable by the GTB insurance carrier
- Knowledge of the benefit programs and eligibility requirements
- Computer literacy, preferably in Microsoft Windows, Word, Excel and other Microsoft office products and data base applications
- Proficiency in the Resource Management (RPMS) specific to Contract Health Work environment
- Knowledge of GTB community
- Detail oriented to include time management and organizational skills
- Ability to work well with a variety of people from differing backgrounds
- Excellent communication skills
- Willingness to work flexible hours at times
- Willingness and ability to travel on a regular basis to satellite offices
- Ability to work independently
- Reliable transportation
- Valid Michigan driver's license
- Willingness and ability to pass a background investigation
- Willingness and ability to pass a drug and alcohol urinalysis
- Adherence to strict company policy in regard to confidentiality
Desired Qualifications
- Bachelor's Degree in Business Administration, Social Work, Health Administration or related field
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