Patient Eligibility Coordinator

Hours Per Week: 40

Job Type: Full-time, Non-Exempt 

Summary/Objectives of Position

The Patient Eligibility Coordinator (PEC) assists, greets, and directs clients and other business guests in person or by telephone in an efficient, courteous, culturally competent, and professional manner. This role is responsible for assisting in identifying the guests’ purpose for visit or call and directs them to the appropriate personnel or resource. The PEC will assist with registering patients to participate in services offered by BAIHP. These duties include coordinating paperwork for clients and supporting with the collection of their health insurance, proof of identity, intake forms, and other relevant registration documents. The PEC is responsible for entering all required patient registration and annual update information accurately and timely into the organization’s electronic health records and RPMS systems. The PEC accurately reviews records for errors and corrects intake forms and registration information to support accuracy in the billing system for the purpose of reimbursement utilizing ICD-10-CM, CPT, HCPCS, HEDIS and proper modifiers. Thus, this role collaborates directly with the Clinical and Behavioral Health and Community Health Departments and is essential to the Cultural Department to ensure accuracy and compliance. The PEC is part of a multi-disciplinary team working together to establish and carry out a case plan for each client and reports directly to the DOO and CEO. Must be able to identify and communicate accurately to clients about their eligibility and patient rights.

Essential Duties, Functions & Responsibilities

• Enter client registration and pre-screen for eligibility. Conduct intake and link all clients to an existing system of care, and follow-up as needed.
• Assists clients with managed care applications, dis-enrollment or enrollment.
• Coordinate with in-house services providers to develop, implement and monitor an individual case plan for each client.
• Assist in filing client records, paperwork, and documents, daily.
• Submit required reports and records when necessary.
• Represents the agency and communicates accordingly at all community, government and business meetings
• Keep logs of all case management encounters
• Review provider documentation to determine the principal diagnosis, co-morbidities and complications, and secondary conditions following official coding guidelines.
• Utilize technical coding principles and learn fiscal management software (e.g., SAGE Accounting for Medical Use) to assign appropriate ICD-I0-CM diagnoses, ICD-I0-PCS as appropriate, DSM-V, and CPT for procedures.
• Ensure to work with coding and billing team by clarifying diagnosis and procedural information through an established query process if necessary.
• Identifies non-payment conditions; Hospital-Acquired Conditions (HAC), Patient Safety Indicators (PSI) following, report through established procedures.
• Collaborate in QAQI process with the Clinical Documentation Improvement and share information with analysts.
• Review patient encounter data for accuracy and provide recommendations for improvement to Analysts.
• Attends training for continuous development in billing, coding, accounts receivable, and leadership.
• Prioritize work to ensure the timeframe of medical record coding meets regulatory requirements.
• Serve as a resource for coding/billing related questions as appropriate.
• Adhere to and maintain required levels of performance in both accuracy and productivity.
• Review and maintain a record of charts coded, held, and/or missing information necessary for registration.
• Provide documentation feedback to Providers, as needed.
• Participate in department meetings and educational events.
• Meet performance and quality standards.
• Abide by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines.
• Proficiency assigning ICD-10-CM, CPT, HCPCS, HEDAS and modifiers.
• Ability to read and comprehend an EOB.
• Proficient in guidelines, CCI, LMRP, coding, use of modifiers.
• Proficient in all aspects of reimbursement (i.e., benefit investigations, payer reimbursement policies, regulatory and administrative rules).
• Adept in physician and insurance reimbursement and billing concepts and procedures, as well as laws and regulations affecting payment compliance, denials, and appeals recovery. Proficient understanding of medical coding systems affecting the adjudication of claims payment and acquiring proficiencies to be at or equal to billing/coder certified.

Minimum Mandatory Qualifications

Education: 

•  High School Diploma or GED required
• Associate's or Technical Degree is preferred or equivalent combination of education and related experience.

Experience: 

• Experience in an ambulatory health center preferred.
• Experience using Electronic Health Records Systems and utilizing systems for Data Entry and Intake packets and Managed Care Plans.
• Three (3) years prior experience in medical or behavioral health in a health care organization, urgent care, or hospital registration desk.
• Must have three (3) years of registration clerk, health office assistant, administrative assistant or patients’ rights advocate. 
• Must have experience with health care case management, Medical Assistant, or Community Health Care Work experience.

License/Certification: 

• Valid CA driver’s license is required.
• Coding Certification from AHIMA or AAPC (RHIA, RHIT, CCS, CCS-P, CPC, or CPC-H) is highly desired.

Skills: 

• Maintain strict confidentiality of client and personal information, adhering to HIPAA, professional codes of conduct, State of CA regulations, and BAIHP policies and procedures.
• Strong Knowledge of health care services and processes for clients and their families. 

Communication Skills:

• Demonstrates proficiency in communication and writing skills.
• Language Skills: Ability to read, analyze, and interpret general and professional documents. 
• Ability to write routine reports and correspondence. 

Interpersonal Skills:

• Ability to foster teamwork; train and direct the work of team members and colleagues.
• Excellent organizational skills, including the ability to work productively and make independent decisions.

Technology

• Familiar with electronic healthcare records systems. 
• Proficiency with using computer-based applications (e.g. Microsoft Office) and clinical information management systems.
• Demonstrates the ability to type 30 words per minute.

Benefits Offered at BAIHP:

At BAIHP, we value our employees and strive to provide comprehensive benefits to support their well-being, financial security, and work-life balance. Here's what we offer:

• 401(k) matching
• Dental, Health, & Vision insurance
• Health savings account
• Life insurance
• Paid time off (Vacation, Sick, Vacation Reward)
• Employee Assistance Program (EAP)

Indian Preference

Bakersfield American Indian Health Project (BAIHP) complies with the Indian Preference Act. Preference in hiring is given to qualified Native Americans under the Indian Preference Act (Title 25, US Code, Sections 472 and 473).  Subject to, but not in derivation of the Act, we are an equal opportunity employer.