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
- 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
- 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
- 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.