Benefits Specialist

About This Role

This specialist role is responsible for identifying patients eligible for alternate resources and assisting them with applications for programs like Medicare, Medicaid, and third-party eligibility with various state, federal, and tribal agencies. The position involves close collaboration with the Social Security Administration, County Department of Human Services, other tribal offices, and third-party payers to coordinate benefits for insured patients. It also entails working closely with patient registration staff to obtain new patient demographic and insurance information prior to appointments.

Responsibilities

• Verify current eligibility for private insurance and Medicaid patients and enter and maintain third-party information in the RPMS patient registration database
• Process incoming mail regarding eligibility
• Determine patient amount due when applicable and communicate closely with front desk staff to ensure proper collection of all co-pays, deductibles, and private pays
• Review appointment list daily to check eligibility
• Verify Soonercare eligibility via the online Oklahoma Health Care Authority website
• Verify insurance information electronically or via telephone
• Enter notes into patient charts or for patient registration to communicate status of resource and/or request to meet with patient to assist with application
• Work closely with Intake staff and Insurance Specialist
• Assist patients as needed with understanding their private insurance, Medicaid, and Medicare benefits
• Coordinate patient benefit interviews to screen for Sooner Care eligibility, assist patients in applying for benefits, and perform outreach activities to determine possible Sooner Care eligibility
• Maintain filing system for eligible patients and those who do not qualify
• Communicate frequently with third-party reimbursement sources to ensure compliance with reimbursement requirements
• Update all patient information in the RPMS system
• Ensure registration and insurance data is accurate and current
• Scan insurance data
• Perform other duties and projects as required by management

Requirements

• High School Diploma or equivalent
• Experience with medical terminology
• Two years of experience in third-party benefits in a medical facility
• Accurate typing/data entry skills
• Good organizational skills and ability to work independently
• Computer experience
• Expanded knowledge of third-party resources with special emphasis on Medicaid and Medicare
• Ability to communicate effectively and accurately with providers, patients, third-party reimbursement sources, and other staff