Patient Health Benefits Specialist



This position is expected to perform a higher level of generally more complex job-specific responsibilities from Health Benefits Specialist I. The Health Benefits Specialist is responsible for providing frontline health benefits enrollment to patients. Serves as a resource and referral resource for patients for initiating health care coverage. The Health Benefits Specialist role is to determine whether patients currently have a third-party payer. If not insured, the Health Benefits Specialist screens and evaluates whether patient may qualify for any known payer sources, i.e., Medicaid, Medicare, VA, Federal Insurance Marketplace, Sliding Discount, and provides assistance to the patient for the enrollment process. The Health Benefits Specialist assists SEARHC to achieve the goal of increasing the number of patients enrolled with a third-party payer.

SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement.

Working at SEARHC is more than a job, it’s a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health insurance, dental, and vision benefits, life insurance and long and short-term disability, and more.

Shift Details

• M-F 8-5

Key Essential Functions and Accountabilities of the Job

• Knows, understands, incorporates, and demonstrates the Mission, Core Values, and Vision in     behaviors, practices, policies, and decisions.

• Maintains collaborative, team relationships with peers and colleagues to contribute to the working group’s achievement of goals effectively, and to help foster a positive work environment. 

• Protects confidentiality/privacy in verbal, written, and electronic forms of communication or information sharing. 

• Raises concerns in an appropriate manner and according to policy. 

• Consistently exhibits behavior and communication skills that demonstrate SEARHC’s commitment to superior customer service, including quality, care, and concern with each and every internal and external customer.  

• Provides exceptional customer service in assisting patients enrolling in third party payers including Medicaid, Medicare, Denali Kid Care, VA, Federal Insurance Marketplace, and Sliding Discount. Obtains and documents necessary information accurately and timely.

• Enter data into MapsIQ health benefit tracking software and other systems. Monitors and maintains statuses from initiation to resolution. Tracks additional data elements as necessary.

• Distributes health benefits material to patients, community members, partner organizations and businesses to build coverage option awareness. 

• Coordinate with local and regional organizations and Tribal Nations to build awareness of coverage options.

• Completes and attends all required training programs and participates in conference calls, webinars or other professional or team development activities.

• Reviews, verifies, and confirms current third-party payer information in EHR.

• Provides administration assistant type work to Health Benefits department including mail outs, data clean up, and other assigned duties.

Meets all requirements of Health Benefits Specialist I in addition to the following

• Coordinates and leads small scale projects. 

• Facilitate educational events and presentations.

• Proficient in public speaking

• Makes meaningful improvement to services, program, processes, and organizational effectiveness that creates new value for patients and employees.

• Acts as a resource, mentor, and trainer for entry-level Health Benefits Specialist I personnel and Patient Access Representatives, as appropriate.

• Orients new Health Benefits Specialist I staff to the department and SEARHC systems and processes.

• Responds to questions on standard procedure and best practices from team members.

• Communicates effectively with patients, physicians, and/or other departments regarding delays or issues relating to health insurance programs.

• Work closely with the Financial Counselors and Patient Access team to ensure coverage is current and documented appropriately in the record. 

• Responds to inquiries regarding status of health coverage by assessing the request and evaluating the circumstances to provide the needed information. 

• Demonstrates superior customer service to all external and internal customers. 

• Communicates effectively with patients, physicians, and/or other departments regarding delays or issues relating to authorizations, PRC Travel and patient appointments. 

• Meets team metric standards and expectations consistently. 

• Maintains strict confidentiality at all times. 

• Identifies compliance/ethics issues and brings forth recommendations for operational improvement. 

• Ensures successful adherence to policies, procedures and changes to the organization. 

• Complete and support additional patient access related activities as assigned. 

• Makes recommendation for FAP/HRSA approval  

• Other duties as assigned.

Additional Details:

Education, Certifications, and Licenses Required

• High School Diploma or equivalent – required.

• Bachelor's degree or 3+ years benefits enrollment experience or equivalent combination of education and experience or demonstrated proficiency

• Certified Application Counselor (CAC) with CMS or obtain within 45 days of hire

• Medicare Counselor Certification or obtain within 6 months

• Completion of Department of Veterans Affairs-Tribal Veteran Representative training or obtain within 1 year of hire

Experience Required

• 3 years of prior experience performing administrative and customer service duties with a preferred one-year of experience performing revenue cycle duties which can include scheduling, registration, health information management, coding, billing, and/or collections experience; or demonstrated proficiency screening patients for insurance and alternate resources

Knowledge of

• Understanding and/or willing to learn tribal health programs and alternate resources

• Knowledge and demonstrated use of customer service principles

• Knowledge of data entry, retrieval, and reporting

• Medical Terminology

• General office functions, office equipment, and computer applications 

• Detail oriented with above average organizational skills 

• Administrative and clerical knowledge including word processing, managing files and records, office procedures, computer software

• Demonstrate time-management and organizational ability

Skills in

• Effective oral and written communication skills

• Skills in using a database

• Performs job with minimal supervision and demonstrates problem-solving skills

• Skills in operating a computer utilizing a variety of software applications

• Working independently and as a team 

• Good interpersonal, verbal, and written communication  

• Strong attention to detail 

• Actively look for ways to help people

• Comfortable with ambiguity, exhibit good decision making and attention to detail

• Develop and maintain effective relationships through clear, encouraging, and timely communication

• Excellent interpersonal skills and have the ability to interact on a professional level with individuals from diverse backgrounds

Ability to

• Ability to multi-task and work independently in a fast paced environment

• Ability to respond quickly in urgent situations with attention to detail

• Ability to problem solve and use conflict resolution skills

• Prioritize work in multi-task in a fast-paced office setting with many interruptions 

• Self-start and willingness to learn 

• Read and comprehend simple instructions, short correspondence, and memos 

• Demonstrate time-management, organizational, and customer service skills 

• Ability to plan, coordinate and arrange travel, meeting spaces, patient appointments, provider and partner trainings while traveling in other communities

• Handle difficult customer situations in a positive manner  

• Interact with external healthcare professionals in a variety of settings  

• Effectively prioritize multiple ongoing tasks and responsibilities under pressure at a steady pace in an unpredictable environment 

• Maintain a professional demeanor with physician and clinical team when addressing concerns regarding imaging orders/diagnoses 

Computer Skills

• Proficient in Microsoft Office Products including Word, Excel

• Database applications

Travel Required

• Travel to assigned communities at least 2 times per year.

• Less than 25% travel expected.

• Travel is by jet, small aircraft, or boat.

Position Information:

Work Shift:OT 8/40

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!