Health Benefits Specialist I

• Family Health Resources Department
• Remote Work Schedule
• 5804 false

US:

AK:

Anchorage or Remote | Administrative | Full-Time 19.40

• 23.

75 USD per hour Posted today Apply Save Description The Alaska Native Tribal Health Consortium is a non-profit Tribal health organization designed to meet the unique health needs of Alaska Native and American Indian people living in Alaska. In partnership with the more than 171,000 Alaska Native and American Indian people that we serve and the Tribal health organizations of the Alaska Tribal Health System, ANTHC provides world-class health services, which include comprehensive medical services at the Alaska Native Medical Center, wellness programs, disease research and prevention, rural provider training and rural water and sanitation systems construction. ANTHC is the largest, most comprehensive Tribal health organization in the United States, and Alaska's second-largest health employer with more than 3,100 employees offering an array of health services to people around the nation's largest state.

Our vision:

Alaska Native people are the healthiest people in the world. ANTHC offers a competitive and comprehensive Benefits Package for all Benefit Eligible Employees, which includes: Medical Insurance provided through the Federal Employee Health Benefits Program as a Tribal Employee, with over 20 plans and tiers. Cost-Share Dental and Vision Insurances Discounted Pet Insurance Retirement Contributions with Pre-Tax or Roth options into a 403(b). 401(a)

ANTHC Retirement Plan:

After one year of employment, ANTHC will begin making matching contributions of up to 5% of your eligible pay, based on your own contributions. In addition, you may be eligible for an annual discretionary contribution of up to 3% from the employer. Paid Time Off starts immediately, earning up to 6 hours per pay period, with paid time off accruals increasing based on years of service. Eleven Paid Holidays Paid Parental Leave or miscarriage/stillbirth eligibility after six months of employment Basic Short/Long Term Disability premiums, Accidental Death and Dismemberment (AD&D) Insurance, and Basic Life Insurance are covered 100% by ANTHC, with additional options for Short-Term Disability Buy-Up Coverage and Voluntary Life for yourself and your family members. Flexible Spending Accounts for Healthcare and Dependent Care. Ancillary Cash Benefits for accident, hospital indemnity, and critical illness. On-Site Child Care Facility with expert-designed classrooms for early child development and preschool. Employee Assistance Program with support for grief, financial counseling, mental/emotional health, and discounted legal advice. Tuition Discounts for you and your eligible dependents at Alaska Pacific University. On-Site Training Courses and Professional Development Opportunities. License and certification reimbursements and occupational insurance for medical staff. Emergency Travel Assistance Education Assistance or Education leave eligibility Discount program for travel, gym memberships, amusement parks, and more. Visit us online at www.anthc.org or contact Recruitment directly at HRRecruiting@anthc.org. Alaska Native Tribal Health Consortium has a hiring preference for qualified Alaska Native and American Indian applicants pursuant to

P.L. 93-638

Indian Self Determination Act.

Summary:

Under close supervision, interview/screen, referred patients to determine eligibility for alternate health resources. Assist the patient with successful completion of applying for eligible programs; Medicaid, Medicare, VA Health Benefits, or Federally Facilitated Marketplace enrollment.

Responsibilities:

Interview and assist patient and families in application process by conducting interviews, over the phone or in person, to determine eligibility for alternate health resources (Medicaid, Medicare, Private insurance, Veterans Administration, Tribally Sponsored Health Insurance Program etc.) Verify and update records and billing system information according to prevailing customer service standards. Must be able to communicate effectively with patients and families to provide updates on application information and required documents needed to present to state department. ANTHC Health Benefits Specialists (HBS) facilitate Medicaid eligibility determinations. HBS personnel receive specialized training and maintain annual certification for Division of Public Assistance Eligibility platforms

• EIS and Aries for real-time application tracking and eligibility verification.

Monitors application workflows, escalates cases requiring expedited processing, and submits correction requests to DPA as needed. HBS provides technical assistance to Tribal Health Organizations (THOs) statewide on system navigation and Alaska Medicaid policy interpretation. Work collaboratively with other members of the team/department, as well as outside agencies and THOs, to identify gaps in compliance and regulation within State programs that limit patient access to healthcare and advocate for positive change via ANTHC Intergovernmental Affairs. Perform insurance verification of benefit coverage on all of patient's insurance plans to complete the necessary data processing procedures in the electronic databases and the necessary forms, paperwork to assure hospital, clinic compliance in addition to any federal, state, county, city, tribal or third party payer requirements. Ensures patient records are complete and correct in all patient information electronic databases, using standardized, quality and production focused processes while delivering excellent customer service. Ensures accuracy of other database systems for accurate processing of information for tracking and reporting. Enters registration data including, but not limited to: demographics, guarantor, insurance, third party payer, and any pertinent information into the electronic databases in a timely and accurate manner. Maintain patient records and confidentiality. Performs other duties as assigned or required.

SPECIALTY TEAM DUTIES

The Inpatient HBS team focuses on securing insurance coverage for hospitalized patients, prioritizing high-cost cases and applications related to births at ANMC and Long Term Care Medicaid. The team collaborates extensively with Admitting, Continuum of Care, and Social Work departments to expedite enrollment for patients with immediate coverage needs. Patient interviews are conducted as necessary for eligibility screening, application support, and consent documentation. Additionally, the team interfaces with billing and insurance verification staff to resolve coverage discrepancies and billing issues, ensuring claims can be processed without delay. HBS assigned to Purchased Referred Care (PRC) receive specialized training for the management of Plexis workload. HBS are responsible for initiating and managing Alternate Resource Screening and Enrollment for beneficiaries referred to non-Tribal health facilities. This process ensures compliance with the Federal mandate that the Indian Health Service (IHS) functions as the payer of last resort, requiring the exhaustion of all available third-party resources prior to PRC authorization. HBS identify and facilitate enrollment in cost-free coverage options. Screening outcomes and eligibility determinations are documented and maintained in the PRC referral management system, Plexis. T-SHIP team members are responsible for providing detailed, goal-oriented, and adaptable support in the delivery of health insurance assistance and program success across Alaska. They must be creative problem-solvers, capable of identifying areas for improvement by analyzing data and collaborating with clinical staff to enhance the revenue-generating T-SHIP Infusion Program. Their duties include providing training to tribal health organizations when needed, assisting patients with insurance enrollment, through the ACA Marketplace and maintaining federal CMS Assister Certification. Team members are expected to communicate complex insurance issues clearly to patients, particularly those undergoing cancer treatment, with compassion and cultural sensitivity. They handle cost-sharing referrals, prioritize work based on financial reimbursement, and engage in community outreach and education to increase awareness of health coverage options. Additionally, they must stay informed on federal and state policies, maintain accurate and secure records, participate in ongoing training, and partner with local organizations to serve underserved communities, while tracking and reporting on outreach and client outcomes.

Other information:

KNOWLEDGE and SKILLS All levels

• Knowledge of Alaska Tribal Health System, ANTHC, and Alaska Native culture(s) and politics.
• Knowledge of health payer resources (Medicaid, Medicare, Private Insurance, Commercial Insurance, Veterans Administration) and the appropriate application process.
• Knowledge of applicable federal, state, and tribal healthcare programs.
• Knowledge of state, federal, and public/private insurance carrier regulations including Centers for Medicare and Medicaid.
• Knowledge of multi-line telephone systems operations.
• Knowledge of basic medical terminology and clinic systems.
• Knowledge of the Privacy Act of 1974 and HIPAA Privacy Rule Act of 1966.
• Skill in typing a minimum of 30wpm.
• Skill in oral and written communication.
• Skill in managing multiple priorities and tasks concurrently and meeting deadlines.
• Skill in establishing and maintaining cooperative working relationships with others.
• Skill in operating a personal computer utilizing a variety of applications .
• Skill in problem solving and working independently.
• Skill in working in multiple settings or department as assigned .
• Ability to work with patients who may be terminally ill, homeless, or require special assistance.

MINIMUM EDUCATION QUALIFICATION A

high school diploma or GED equivalent.

MINIMUM EXPERIENCE QUALIFICATION

Health Benefits Specialist I Non-supervisory

• One (1) year of experience, within the last 12 months, working in an office setting with health insurance experience to include Medicaid, Medicare or the Health Insurance Marketplace, performing data entry, quality customer service, in-person and on-phone customer interactions, email correspondence with members of the team and other members of the organization as well as outside agencies.

Must be capable of mastering outpatient screenings for referred patients. Health Benefits Specialist II Non-supervisory

• Must have 2 years' experience, working in a medical office setting with health insurance experience to include Medicaid, Medicare or the Health Insurance Marketplace, performing data entry, quality customer service, in-person and on-phone customer interactions, and email correspondence with members of the team and other members of the organization as well as outside agencies.

AND Must have successfully mastered two (2) of the following areas of HBS duties and have a combined total of 2 years' experience in those areas. Experience at an outside agency may be included but will be reviewed on a case by case basis. Inpatient screening Outpatient screening Purchased referred care screening and enrollment Tribally-Sponsored Health Insurance Program (TSHIP) Health Benefits Specialist III Non-supervisory

• Must have 3 years' experience, working in an office setting with health insurance experience to include Medicaid, Medicare or the Health Insurance Marketplace, performing data entry, quality customer service, in-person and on-phone customer interactions, email correspondence with members of the team and other members of the organization as well as outside agencies, and knowledge of community resources.

AND Must have successfully mastered Three (3) areas of HBS duties and have a combined total of 3 years' experience in those areas. Experience at an outside agency may be included but will be reviewed on a case by case basis. Inpatient screening Outpatient screening Purchased referred care screening and enrollment Tribally-Sponsored Health Insurance Program (TSHIP) HBS Trainer

MINIMUM CERTIFICATION QUALIFICATION N/A PREFERRED EDUCATION QUALIFICATION N/A PREFERRED EXPERIENCE QUALIFICATION N/A PREFERRED CERTIFICATION QUALIFICATION N/A ADDITIONAL REQUIREMENTS N/A

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