Benefits Coordinator

1 day ago

Remote, Oregon, United States Family Health Center Of M Full time $100,000 - $120,000 per year

JOB SUMMARY

The Benefits Coordinator is responsible for the daily operations of the prepaid sliding fee program.  This individual screens applicants, facilitates benefit eligibility and enrollment, and maintains accurate and up-to-date records within relevant databases.  The Benefits Coordinator collaborates with internal departments and external partners to support members with benefit-related inquiries and ensure effective coordination of services.

ESSENTIAL JOB FUNCTIONS

  1. Screens prospective members to determine eligibility and appropriate benefit levels in accordance with program guidelines.
  2. Conducts interviews with applicants to explain covered benefits, member responsibilities, and assess program fees based on established criteria.
  3. Assists members in evaluating available healthcare coverage options and connecting with appropriate community resources.
  4. Delivers high-quality customer service by addressing and resolving inquiries or complaints from members, applicants, and providers regarding eligibility, benefits, and claims.
  5. Verifies member-reported changes, adjusts program fees as necessary, and conducts periodic audits to confirm ongoing eligibility.
  6. Oversee program fee payment processes, including initiating payment reminders and negotiating payment arrangements with members.
  7. Processes income updates and issues revised member communications and identification cards as appropriate.
  8. Ensures all documentation is accurate, complete, and meets established eligibility and compliance standards.
  9. Maintains and updates member databases for tracking, reporting, and communication purposes.
  10. Provides guidance to members transitioning to Medicare or other benefit programs (e.g., Low-income Subsidy, SeniorCare) and facilitates coordination of new benefits.
  11. Confirms and verifies members' primary insurance information to ensure accurate benefit coordination.
  12. Supports internal and external audit processes to ensure compliance with grant requirements and proper use of indigent drug programs.
  13. Maintains strict adherence to scheduled work hours with regular and reliable attendance.
  14. Performs other duties as assigned.

EDUCATION AND EXPERIENCE

  1. High school diploma or equivalent.
  2. Two years of experience in a medical or business office, health insurance, public agency, or social program setting.  
  3. Proficient in Microsoft Office Suite.  
  4. Knowledge of basic business math principles, including calculations and percentages with ability to interpret financial statements and tax returns.

CERTIFICATIONS / LICENSES

  1. Certified Application Counselor (CAC) designation through the Centers for Medicare and Medicaid Services must be obtained within three months of the first CAC training period offered after hire.  Employees hired less than three months before the start of the training period may defer certification until the following year.  Preferred certification at time of hire.
  2. Employees must pass the CAC certification exam within three attempts and within three months of completing training. Failure to meet this requirement may result in termination, unless extenuating circumstances are approved.
  3. Preferred Wisconsin Accident and Health Insurance Agent License at the time of hire.
  4. Valid Wisconsin Driver's License required with an acceptable motor vehicle record (MVR), per FHC guidelines.

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