Relief Alternate Resource Specialist l

POSITION SUMMARY

The purpose of thisposition is to seek out, identify, and encourage eligible patients andcommunity members to obtain benefits that may offset some or all of the costsassociated with the patient’s treatment. This position identifies and informspatients of eligibility of programs and/or benefits, verifies and assists incompletion of claim forms and benefit applications. This position verifiesdaily inpatients and notifies URand/or Case Manager in order that they may obtain timelypre-certifications/pre-authorizations. This position assists residents in localand village benefit enrollment projects, submits applications, travelrequisitions, other appropriate paperwork within 48 hours of receipt and/ormeets deadlines. This position updates, maintains, and keys eligibility listson a monthly basis. This position submits documentation on newborns weekly toappropriate agencies. Reports directly to the Alternate Resources Supervisor.

PRINCIPAL DUTIES ANDRESPONSIBILITIES:

1.Identifiespatients and community members who may be eligible for alternate health benefitresources of other programs where eligibility for that program may in turnqualify the patient for alternate health benefit resource funding.

2.Workswith the patient and/or community member to identify which alternate benefitresources may be applicable, based on knowledge of the eligibility criteria forthe various programs.

3.Assistspatients or other responsible person(s) in determining eligibility for avariety of programs, e.g., Medicaid (with an emphasis on the Alaska Children’sHealth Insurance Program), Medicare, VA, private insurance, and submits weeklydocumentation on newborns. Assists the Medicaid Specialist and Biller to ensureclean claims submitted first time, due to program information updates.

4.Workswith others who may be aware of the patient’s situation of eligibility forbenefits, e.g., village representatives, employers, private insurancecompanies, etc., if the patient needs assistance in this process.

5.Mustutilize skill in eliciting sensitive information from patients and communitymembers regarding personal relationship, finances, family history, etc.

6.Assiststhe patient in the application or appeal process to determined benefiteligibility.

7.Submitsthe required forms and documentation to the proper agencies within requireddeadlines and follows up.

8.Obtainsadditional information from the patient or others as needed to avoid delays inthe processing of the claim.

9.Ensuresprocedural compliance of the alternate health resource information gatheringprocess and the primary payer requirements of Federal Regulations.

10.Maintainscommunication and a cooperative relationship with various Federal, State,Municipal, Civic, Native and other service organizations to obtain and useresources of referred patients.

11.Initiatesand assists patients with the appeals process if the initial application isdenied for patients that appear to be eligible for benefits.

12.Maintainsrecords of eligibility data for each patient and maintains completedocumentation to ensure the use of the Express Application system.

13.Advisesand assists patient registration especially in regard to verifying eligibilityrequirements for Medicaid, Medicare, VA, insurance companies and otheralternate health benefit resources.

14.Travelsfrequently for training and in small planes to villages and by snow machine andother non-traditional means to canvas communities and participate in enrollmentprojects for eligible parties.

15.Establishesa routine program for patient education and regular Public Service Announcementsto achieve targeted goal.

16.ResourceSpecialist II must maintain the program budget and make sure grant guidelinesare followed.

17.Performspatient registration assuring all information is current in the RPMS system.

18.Performsother duties as assigned as needed by program.

MINIMUM REQUIREMENTS:

AlternateResource Specialist I:

High School Diploma orequivalent required.Requires one year’srelevant experience. Prefer six months’ registration experience. Must be ableto type well enough to accomplish job duties. Basic Microsoft Word and Excel experiencerequired. Inupiaq speaking ability is preferred.Must be able to communicate orally andpresent presentations to explain various program requirements to patients,whether individuals or groups. RPMS experience preferred but not required.Must be able to do public serviceannouncements.Must be able to travelovernight to villages in small planes.Abilityto lift 40 pounds.Ability toeffectively communicate and work well with others.

Alternate ResourceSpecialist II:

Must meet all of theabove qualifications of the Benefit Resource Specialist I.Requires additional two years of relevantwork experience. Must demonstrate proficiency in knowledge of Medicaid,Medicare, VA, DKC, and third party payorState and Federal rulesand regulations. Must be able to work with minimum or no supervision.Must be able to maintain program budget andan understanding of grant guidelines.