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Benefits Coordinator, Medicare/Medicaid

Lake Oswego, Oregon · Healthcare
SUMMARY:  The Benefits Coordinator has primary responsibility for ensuring that all Oregon Sisters of the Holy Names of Jesus and Mary (SNJMs or Sisters) receive appropriate health insurance and public benefits based on their individual needs and circumstances and upon SNJM Health & Well-Being guidelines.  This position directly assists Sisters in accessing their benefits and is responsible for maintaining current and accurate benefits information in paper and electronic files following Province guidelines. Provides administrative support to the Director of Benefits and the Clinical Care Coordinator.
 
ESSENTIAL DUTIES AND RESPONSIBILITIES:
 
  1. Meets with Sisters in their residences or in the Health and Well-Being office to assess individual Sister’s benefits and insurance coverage needs, in close collaboration with the Oregon Care Coordination Team and under the Director of Benefits.
  2. Compares how benefits complement each other to meet specific needs of each individual Sister’s situation and recommends benefits tailored to their needs, circumstances and specific benefit eligibility. Explains to the Sister all relevant requirements and expectations for the Sister’s compliance with those requirements.
  3. Under the direction of the Benefits Director and CFO obtains accurate and current information on income and assets and their sources (i.e. Social Security, patrimony, pension, personal budgets, bank accounts, annuities, trusts, etc) to determine eligibility for public benefits, health insurance and Oregon Health Plan coverage.
  4. Assists Sisters in accessing benefits, which may include arranging appointments, making telephone calls to agencies. Under the direction of the Director of Benefits may accompany a Sister to appointments to access public benefits.
  5. Under the direction of the CFO and the Director of Benefits this position completes applications and recertification's for Social Security, Medicare, SSI, Medicaid and Medicare Savings Programs for eligible individuals according to application rules and deadlines.  Completes enrollment applications for Medicare Advantage health plans, Medicare Supplemental plans, and other health, dental and prescription plans as needed.  Assists Sisters with participation in Medicare Part D by assisting with choices of PDPs and completing applications for the Limited Income Subsidy (LIS).
  6. Assesses and monitors benefits’ status of Sisters to identify key decision points such as ending employment, change in living situations, reaching age 62 or 65, , etc.  Recommends appropriate benefits changes and collaborates with Sister to ensure timely enrollment so there are no coverage gaps or missed opportunities.
  7. Educates Sisters and is available to answer their questions regarding benefit eligibility requirements, coverage, billing statements and claim status.  Advocates as necessary to ensure benefits are received in accordance with the benefit plan or public program. 
  8. Proactively keeps the Director informed of patterns and trends observed in day to day benefits issues specific to Oregon to maximize appropriate use of benefits and minimize costs. Consults with Director on complicated benefit questions and/or benefit matters involving more than an individual situation.  Reports situations in which benefit eligibility requirements have come into question and seeks assistance from the Director in appropriately resolving these situations.
  9. Tracks benefit applications, eligibility determinations, redeterminations and ineligibility issues and benefit termination by speaking with Sisters and monitoring changes in programs. Maintains complete and current records of each Sister’s health insurance and public benefits.  Enters benefit information for each Sister into the Benefit Records of the Province database in a timely manner.  Maintains confidential records of benefit information in paper files.  Mails necessary forms and other documents in order to comply with application deadlines and procure necessary information for benefit eligibility. Notifies insurers and benefit providers upon a Sister’s death.
  10. Reviews bills, and as needed, resolves related problems to assure insurance and public benefits have paid for all covered medical care, prescription, DME and related services.  Seeks consultation for unusual or new areas of expense; Forwards requests for expenses not covered by insurance or public benefits to the Director of Benefits for payment from Province funds.
  11. Provides administrative support to the Director of Benefits, the Clinical Care Coordinator and the Assistant Clinical Care Coordinator. (Examples include filing, updating face sheets, referrals to physicians and other providers, transportation scheduling, sending packets to new doctors, and being a primary point of contact for the Sisters).
  12. Assists with scheduling care coordination visits, and with obtaining equipment, supplies, and specialty items needed by Sisters.
  13. Provides Province wide assistance for the Sisters in ordering, maintaining, and tracking communication services under the Great Call contract to include monitoring for equipment needs, orders, replacements and updating online contact information.
  14. Other related duties as identified and/or assigned.
 
INTERRELATIONSHIPS: Works in close collaboration with Oregon Health and Well-Being Team, Sister Services, Province Health and Well-Being Department, Sisters, Mary’s Woods’ staff; durable medical equipment (DME) providers, physician/provider offices; and with county, state and federal agencies such as Department of Human Services, Social Security and Centers for Medicare & Medicaid Services and others as needed.
 
QUALIFICATIONS:  To perform this job successfully, individuals must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skills, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 
Education:     Bachelor’s degree or a combination of post-secondary education and experience that will enable the employee to successfully fulfill the responsibilities of the position.
                        SHIBA Certification a plus.
 
Experience:   Minimum of 2 years’ experience coordinating Medicare/Medicaid or other public benefits and health insurance for persons over 65.  One to two years’ experience in healthcare environment.
 
 
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:
  • Must be supportive of the mission of the Sisters of the Holy Names of Jesus and Mary. 
  • Must model SNJM Guiding Values in carrying out work activities and responsibilities.
  • Must respect and maintain confidentiality of sensitive information.
  • Understanding of and ability to maintain appropriate professional boundaries.
  • Ability to work independently and also as part of a team; ability to analyze and prioritize work assignments and execute tasks in a timely manner.  Proven attention to detail and high degree of accuracy.
  • Ability to learn new and complex information about social, health and income benefits, and public entitlements.  Knowledge of medical terminology.
  • Ability to complete handwritten and online applications for benefit eligibility determination.  Must be able to read/comprehend cursive handwriting.
  • Demonstrated ability to communicate professionally, empathetically, and compassionately with elder population who may be ill, disabled, hospitalized, and/or experiencing loss.
  • Ability to maintain collaborative, professional relationships with SNJM Sisters, staff, and external contacts. 
  • High degree of flexibility and adaptability to shifting priorities and time constraints.
  • Proficient knowledge of Microsoft Office 2010 and other computer software programs including, but not limited to, Word, Excel, Outlook, and Internet Explorer.  Experience with electronic record keeping systems required.
  • Demonstrated written and verbal skills to assure effective communication.
  • Demonstrated ability to provide excellent customer service while also maintaining HIPAA compliance.
  • Ability to respond to emergencies appropriately and calmly as needed.
  • Valid drivers’ license.
 
SNJM is committed to continually building a workplace that exemplifies its values and vision of being hospitable to everyone.  The Sisters of the Holy Names of Jesus and Mary (SNJM) is an Equal Opportunity Employer.
 
We offer a competitive salary and benefits package including medical/dental, group life and disability coverage, a 401K plan, and paid time off.
 
To learn more about the mission and vision of the Sisters of the Holy Names visit: www.snjmusontario.org
 
To Apply: In order to be considered an applicant for this position, please complete our online employment application at https://snjm.catsone.com/careers.  Click “Apply Now” to complete and submit the online application
 

 
 
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