Eligibility Coordinator Job at Yellowhawk Tribal Health Center
Job Summary
The Eligibility Coordinator (EC) is responsible for verifying eligibility for services provided within Yellowhawk Tribal Health Center (Yellowhawk) by ensuring patients meet all Federal Regulations and/or policies for obtaining services. The Eligibility Coordinator is the first person that the patients have contact with at Yellowhawk Tribal Health Center. All duties and responsibilities will be performed in accordance with the Yellowhawk Mission and Vision statements.
Essential Job Functions
- Responsible for checking and obtaining all demographic patient information and ensuring all mandated fields within the system are complete and accurate with updated information.
- Responsible to make eligibility determination of Direct Care Only or Purchase/Referred Care.
- Will be responsible to learn all aspects of Third Party carriers and understand insurance types and benefits such as Medical, Pharmacy, Dental, etc., and know/understand basic language and acronyms with regard to insurance. This includes proper use of group numbers, carrier names, types of carriers, etc.
- Responsible for checking and verifying eligibility for any alternate resource for Medical, Dental, Behavioral Health and Pharmacy coverage.
- Responsible to track any pending eligibility status and notify appropriate staff.
- Responsible to work with patients and utilize on-line eligibility tools to verify insurance coverage for patients. (MMIS, Availity, etc.)
- Must work as a team with all departments and keep up to date on rules and regulations with regard to all data entered into the RPMS/EHR.
- Responsible to work with the Outstation Outreach Workers ensuring that all Yellowhawk patients have healthcare coverage.
- Strict adherence to all HIPAA regulations.
- Other duties as assigned
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