Job Title: Contact Representative

Department: Tohono O'odham Nation Health Care (TONHC)

Division: San Xavier Patient Accounts

Status: Non-Exempt/Full-Time

Salary: $25.76/hr - $37.31/hr (DOE)

Position Summary:

Responsible for assisting families and individuals in applying alternate resources, variety of problems, questions, or situations, and explaining various benefits options, qualifying, conditions, and reporting requirements. Ensure the identification of patients eligible for alternate resources and advocate for patients in effectively utilizing alternate resources.

Scope of Work:

This position is located within the Tohono O’odham Nation Health Care, to include San Xavier Health Center, Santa Rosa Health Center, and San Simon Health Center of the Tohono O’odham Nation Indian Reservation. The incumbent is under the general supervision of the respective Facility Director or the Coordinated Care Branch Chief. The supervisor makes assignments by outlining or discussing issues and defining objectives, priorities and deadlines. The incumbent is expected to train or provide instructions to other employees, but not directly oversee or direct work of others.

Essential Duties and Responsibilities: (Depending on the area of assignment, an incumbent may not be required to perform some of the duties listed below):

• Provides leadership and acts as an advocate for patients in the effective utilization of alternate resources such as Medicare, Medicaid, Department of Veterans Affairs (DVA), Bureau of Employment Compensation (BEC), Private Insurance, Children's Special Health Services, Aid to Families with Dependent Children (AFDC).
• Ensures maximal identification of persons who have, or are eligible for, alternate resources by effectively implementing a screening method and effectively interviewing patients or their families.
• Work closely with all staff to identify and utilize all alternate resources available to the Tohono O’odham Nation population.
• Advises and assists families and individuals in the application for the use of alternate resources.
• Advises and assists with a variety of problems, questions, or situations.
• Assist the individuals in outlining their situations and state the reason for their inquiry. Explains various benefits options, qualifying conditions, and reporting requirements that apply.
• Establishes eligibility of potential Medicare eligible by working with the Social Security Administration (SSA) on both the local and regional levels.
• Works closely with Local County and Tribal agencies to establish eligibility for Medicare, AFDC, Supplemental Social Security Income (SSI).
• Verifies eligibility by contacting local agencies and programs.
• Interview all patients eligible for Medicare and Medicaid benefits to ensure they understand their entitlement.
• Works with patient registration/receptionists in screening for potential eligibility.
• Works with social services and other disciplines that may assist in developing registers of eligibility through their current activities related to determining the health status of the elderly.
• Assists patients with applications for alternate resources, providing transportation and interpretation of rules and regulations.
• Provides information on rights and benefits for multiple alternate resources and tactfully advises patients of non-payment or claims approval.
• Exceeds merely explaining benefits and serves as a patient advocate by personally intervening in the patient’s case with multiple third-party sources, including hospital contact health care and direct decisions.
• Follows up on all pending eligibility claims and works closely with families and agencies to see that the patient is not discriminated against because of their dual role as citizens and as a Tohono O’odham Nation Hospital services recipient.

Knowledge, Skills, and Abilities:

• Knowledge of the Tohono O’odham culture, customs, and traditions.
• Knowledge of Medical/Medicaid, SSA, County DSS offices, Tribal Programs, and other related agencies' policies and procedures.
• Knowledge of establishing registers for eligible patients in varied programs.
• Knowledge of business office and Coordinated Care Branch to perform routine day-to-day duties.
• Knowledge of the Privacy Act of 1974 mandating the incumbent shall maintain complete confidentiality of all administrative, medical, and personnel records and all other pertinent information that comes to their attention or knowledge.
• Knowledge of the eligibility requirements for Medicare, Medicaid, SSI, Migrant workers' health fund.
• Knowledge of eligibility requirements for I.H.S. Direct Care Eligibility and I.H.S. Contract Health Services Eligibility.
• Must possess tactfulness and the ability to deal effectively with patients of diverse backgrounds and deal effectively with health care professionals in different disciplines.
• Ability to analyze patients’ private insurance benefit packages effectively communicates and provides the patient and Health Center utilization options.
• Ability and skill to interview patients in-depth to determine eligibility or alternate funding.
• Ability to effectively communicate to the patient what specific information is needed, the reason for that information, and able to ascertain that it is as accurate as possible.
• Ability to determine who is eligible for alternate resources.
• Ability and skill to compile and write reports from various documents maintained within the Coordinated Care Branch (CCB) or Business Office from both internal and external sources.
• Ability to review a variety of schedules and analyze data printout reports.
• Ability to maintain an excellent public relations attitude and a cooperative and considerate attitude toward others.
• Ability to follow directions and absorb material qualities necessary to the efficient performance of assigned duties and responsibilities.
• Ability to work independently and meet strict timelines.