Benefits Representative
Job description
Are you interested in making a difference and being part of a dedicated, highly skilled professional team providing patient-centered care to a community with unique needs?
At the Greater New Bedford Community Health Center, we strive to provide high quality care to meet the challenging needs of our diverse patients who need more than just health care. We offer a variety of services to the community, including primary & urgent care, women’s health, pediatrics, adult medicine, behavioral health and dental care. Our patients develop strong bonds with our staff and rely on them for health care, as well as guidance with some basic needs that others may take for granted.
Our mission to our patients is to educate and inspire them to be a participant in their total health care. Our mission to the community is to be a resource and leader.
We are the PILOTS of outstanding primary care!
Patient-Centered:
We empathize with each patient, speak their language, and go above and beyond to meet their unique needs.
Innovative:
Our approach to providing quality care is dynamic, collaborative and adaptive.
Local Partners:
We are fully engaged as a primary agent for positive change.
Obliging & Respectful:
Our health center strives to maintain an accepting, safe, confidential and courteous environment for all. Every patient is welcomed, just as every employee is valued.
Team Players:
Our teams work closely & collaboratively with a focus to serve our patients and the community.
Our vision is to improve the health & well-being of each patient, their families, and the greater community.
If you are interested in an exceptionally rewarding opportunity, then we would love to speak with you!
Greater New Bedford Community Health Center is an equal opportunity employer and does not unlawfully discriminate based on race, color, sex, national origin, religion, age, genetic information, disability, veteran status, or any other lawfully protected status. EOE/AA/M/F/D/V
Hours:
Full-Time 40 hours - Monday - Friday 8:30am - 5:00pm
Responsibilities:
- Ability to understand, explain and apply Masshealth/Health Safety Net care regulations, rules, policies, procedures, etc., governing free care and/or government programs.
- Determines the applicability of data and draws conclusions to make appropriate recommendations.
- Gathers information through questioning patients and examining documents to determine financial and categorical status of patient which screens a patient for any governmental programs for which they may be eligible.
- Maintains files of all completed MBR/HSN applications and supporting income documentation in alphabetical order. In addition, ensures that virtual gateway number is maintained on the application.
- Orients all self-pay patients and the underinsured patients regarding programs within the Health Center. Responsible for collection activities on aging accounts on a daily basis along with productivity reports that need to be given to the benefits supervisor on a monthly basis.
- Responsible for the process of MBR/HSN care, partial HSN, (i.e., setting up deductibles, payment plans). Oversees completion and verifies that each application is filed correctly.
- Responsible for gathering supporting documentation for MBR/HSN, Care at the Health Center. Responsibilities include eligibility criteria, eligibility process, advising Medisense, keeping updated documentation/ audits from the Division of Health Care Finance.
- Maintains daily, weekly tickler system for uncompensated care within 90 day period.
- Responsible for processing all incoming Massachusetts Managed Care mail. Orients all new patients and re-enrolled PCC, file documentation and all paper work related to Mass Health Managed Care. Input all Mass Health, Managed Care information into the computer system. Contact all Mass Managed Care patients via telephone and mail regarding establishment with the Health Center periodically.
- Answers calls from patients regarding bills received and offer help if possible, or directs them to the appropriate party at the billing department.
- Reviews documents received by incoming mail and Benefits Department. Coordinates medical benefit request applications with income documentation received. Forward to Central Processing Unit and mail the supporting documentation to the state for approval.
- Able to process incoming calls from patients related to MBR/HSN care applications and assist with questions within own scope of the position.
- Responsible for tracking approval letters for Masshealth "Executive office of health and human services"
- Responsible for inputting approval information into the MSI system in order to update the insurance carrier information.
- Administrative resource to the health center for assisting clients with eligibility criteria for Masshealth, by completing the Medical Benefits Request. To assist patients with enrollment in the centers preferred managed care plan and following up on patient compliance and understanding of managed health care. Responsible for tracking and reporting all activities to the program coordinator on a weekly basis.
- Educate patients, community organizations, agencies, and key advocates about managed care. Includes educating on concepts of managed care, the re-determination process and how to effectively utilize services in a managed care environment.
- Responsible for assisting NHP in the retention of exiting NHP members at the site. Responsible for contacting patients by phone and/or in person to complete the paperwork necessary to retain Masshealth eligibility for members.
- Responsible for utilizing re-determination data to flag their own registration system with redetermination dates for health center patients. For patients with an invalid phone, a letter/flyer will be mailed out urging them to contact a staff person for assistance with the redetermination form.
- Support the registration and referral staff involvement when referring patients to the managed care department for help with the re-determination form.
- High School diploma or GED
- Experience in computer data entry required.
- Excellent typing, telephone and interview skills required.
- Availability to work evening sessions and occasional weekends.
- Ability to work independently with a minimum of supervision.
- Fluency in Spanish or Portuguese, in addition to English, preferred.
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