Health Program Benefits Specialist

      • Job Tracking ID: 512409-740738
      • Job Location: Coos Bay, OR
      • Job Level: Mid Career (2+ years)
      • Level of Education: 2 year degree
      • Date Updated: August 21, 2020
      • Years of Experience: 2 - 5 Years
      • Starting Date: ASAP
      • Close Date: Open Until Filled
      • Job Type: Full Time
      • Starting Salary: 20.38/hour DOE
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    Job Description:

    SUMMARY

    This position is primarily responsible for assisting Tribal members navigate the Federally Facilitated Marketplace (FFM), One (Oregon Health Plan), Veterans Administration (VA) programs and other alternate resources for health care. The Tribal Benefits Specialist works directly with Tribal members to find programs and resources that meet their individual and family needs. The Specialist also works with Health Services Division leadership to identify opportunities and negotiate contracts with providers and vendors for pharmacy, dental, and medical services.

    PRINCIPAL ACTIVITIES & RESPONSIBILITIES

    • Work with providers, insurance carriers, and HSD leadership to negotiate contracts and discounts for services provided to CTCLUSI Tribal members.
    • Assist Tribal Members in enrollment for insurance, Medicare, Medicaid, Marketplace, and any other applicable programs such as One (Oregon Health Plan portal), VA benefits, etc.
    • May also assist Tribal members in options for the purchase of private insurance for themselves and their families.
    • Work with HSD leadership on the Tribal Premium Sponsorship Program (TPSP).
    • Assist Dental Clinic in Medicaid enrollment.
    • Function as PRC Site Manager for RPMS and work with the Portland Area Office (PAO) of Indian Health Service (IHS) to ensure accurate data transmission.
    • Audit patient registration to ensure data accuracy.
    • Review requests for preauthorization of services and make recommendations to HSD leadership for approval or denial.
    • Run reports to check Medicaid status and process renewals.
    • Monitor and manage eligibility of Tribal members for programs and alternate resources. Monitor utilization of healthcare services and referrals made for specialized care to local providers and vendors to assure appropriateness, quality, and cost effectiveness.
    • Perform utilization review of hospital admission and specialty referral patterns.
    • Assist Purchased/Referred Care Specialists as needed.

    PHYSICAL & MENTAL DEMANDS

    • Must be able to walk, talk, hear, use hands to handle, feel or operate objects, tools, or controls, and reach with hands and arms.
    • Vision abilities required by this job include close vision and the ability to adjust focus.
    • Must be required to push, pull, lift, and/or carry up to 40 pounds.

    WORKING CONDITIONS & ENVIRONMENT

    • Moderate noise level with frequent interruptions and distractions.

     

    Experience and Skills:

    MINIMUM JOB REQUIREMENTS

    • Associates Degree in Business Administration, Bookkeeping or Medical Accounting with two years of experience or any combination of education, experience and training that demonstrates the knowledge, skills and abilities to perform the above-described duties. Bachelor’s Degree preferred.
    • Excellent oral and written communication skills required.
    • Demonstrated computer proficiency, including MS Word, Excel and Outlook.
    • Ability to work with local, state and federal health agencies required.
    • Must be willing to complete National Incident Management System (NIMS) training for NIMS certification as arranged by the Tribes.
    • Must be at least 18 years of age.
    • Must possess reasonable ability to communicate in English.
    • This is a covered position and will be subject to pre-employment drug testing and criminal history background check which will include fingerprinting.
    • Must have employment eligibility in the U.S.
    • Indian preference will be observed in the hiring process.