Salt River Pima-Maricopa Indian Community

Scottsdale, Arizona, United States

Benefits Coordination Manager

Posted 9 days ago

Job Description

Definition

Definition : Under general supervision of the Chief Financial Officer, this position provides primary oversite and responsibility for the HHS Benefit Coordination Program. Manages a team of Benefit Coordinators whose primary responsibility is the identification and enrollment of qualified clients in eligible benefit programs such as Medicaid, Medicare and the Federal Marketplace. This team acts as a resource for enrollment and continuously focuses on increasing participation in the HHS Benefit Services. Provides oversight and leadership on the processing of demographic and third party information for alternate resources (Medicaid, Medicare, & Affordable Care Act) and to provide operational guidance as needed to the other benefits coordinators. Coordinates program eligibility and appropriate referrals to other departments. Demonstrates the utmost discretion, privacy and confidentiality in protecting client and program information. Provides training and direction to staff regarding daily operations, insurance verifications, & assistance with applications. This job class is treated as FLSA Exempt.

Essential Functions : Essential functions may vary among positions and may include the following tasks and other characteristics. This list of tasks is ILLUSTRATIVE ONLY and is not intended to be comprehensive listing of tasks performed by all positions in this classification.

Examples of Tasks

1. Workflow, supervision and management:
  • Provides full technical and administrative supervision to the Benefit Coordinators.
  • Prepares shift schedules, and coordinates time off for Benefit Coordinators.
  • Approves time
  • Develops and updates the benefits program policies, practices, procedures and methods to provide a uniform set of program guidelines.
  • Maintains benefit coordinator operations by initiating, coordinating, and enforcing program, operational and personnel policies and procedures.
  • Outlines goals and objectives for evaluation, evaluates performance of Benefit Coordinators and conducts timely performance evaluations.
  • Provides training and leadership for the Benefit Coordinators to accomplish the Community's revenue and health insurance goals.
  • Ensures safe and clean working environment by coordinating Benefit Coordinators following procedures and when necessary.
  • Ensures Benefit Coordinators adhere to all department and AHCCCS related documentation requirements.


2. Team Management and Training:
  • Evaluates processes and procedures within scope of the Benefit Coordinator role for quality standards, recommends changes to meet the organizational goals.
  • Operates within the departmental budget for operations (personnel and supplies).
  • Provides input for the annual budget process to support budget expenditures for benefits coordination.
  • Maintains documentation of benefit coordination services by auditing records.
  • Responsible for the orientation and education of staff to ensure compliance with new and existing regulations of third party payers.
  • Trains new employees and holds periodically trainings on changes with AHCCCS, Medicare, ACA and the Federal Marketplace.
  • Trains new employees and holds periodically trainings on changes with AHCCCS, Medicare, ACA and the Federal Marketplace.
  • Manages development and enhancement of the HHS Benefit Services program.


3. Monitoring Medical Insurance Enrollment :
  • Ensures team utilizes all available methods to identify client eligibility for AHCCCS, Medicare or the Federal Marketplace.
  • Ensures all eligible participants stay enrolled in a health insurance program.
  • Ensures patients are interviewed and assisted with gathering all pertinent information to complete the application process.
  • Develops and continually improves a set of processes, procedures and standards to enhance the enrollment program. This includes, but is not limited to, the following:
  • Eligibility Screening: Develops tools and criteria for program participation
  • Income Qualification: Includes income verification, pay stubs, etc.
  • Application: Assists clients with new applications, report of changes and renewals.
  • Monitoring: Documents daily proactivity
  • Maintaining eligibility vigilance, initial enrollment and renewals for clients
  • Monitors updated insurance entries and documentation of work efforts into client files and referrals for work performance accuracy.
  • Monitors AHCCCS renewal report on a monthly bases to ensure current AHCCCS participants keep their AHCCCS coverage.
  • Ensures team provides Medicare counseling and maybe assisting with enrollments as it relates to participation in the program.
  • Ensures team works with Salt River Integrated Health Care Purchased Referred Care to assist clients to apply for alternate resource for program eligibility.
  • Performs continuous research and updating of information involving changes in rules and regulations for the Affordable Care Act, and alternate resources.
  • Researches benefits related issues, concerns and works to resolve problems.
  • Recommends courses of action for problem resolution.
  • Helps solve Per Capita & eligibility problems relating to program participation.


4. Community Outreach, Program Education & Communication :
  • Responsible for promoting and educating the Community about the services and benefits of enrolling into Health insurance through the Benefit Services program.
  • Coordinates all available resources to inform and educate potential stakeholders about the program including, but not limited to, health fairs, flyers, direct mail-outs, newspaper articles, advertisements, electronic signage, payroll stuffers, brochures etc.
  • Develops creative and innovative methods to educate and communicate with potential program participants.
  • Provides program benefits information and training to staff as required.
  • Coordinates all community outreach.


5. Reporting & Administration :
  • Assumes primary responsibility for the HHS Benefit Services Program benefits coordination, enrollment and reporting.
  • Generates benefits related reports as necessary to document program metrics and participation.
  • Maintains an accurate and up-to-date database of client participants and potential participants including eligibility status, dates, contact information, etc.
  • Responsible for the development and updating of program flyers, brochures and/or media related to the program.
  • Establishes and maintains a working relationship with Medicare and Medicaid intermediaries, Social Security, state and federal agencies, and tribal offices.
  • Responsible for monthly KPI Reporting to HHS Administration.
  • Responsible for submitting monthly Medicare statistics to Intertribal of Arizona.
  • Works with other department staff and outside partners to bring value to participants and the program.
  • Maintains a member of the HEAplus Community Assister Training Team.
  • Analyzes program enrollment trends and reports to the Chief Financial Officer as necessary.
  • Protects client personal privacy, security and program confidential information in compliance with the Health Insurance Portability and Accountability Act (HIPAA).


6. Miscellaneous: Performs other job related duties as assigned by the Chief Financial Officer or HHS Director.

Knowledge, Skills, Abilities and Other Characteristics:
  • Knowledge of the history, customs, culture and traditions of the Salt River Pima-Maricopa Indian Community.
  • Knowledge of generally accepted benefits administration practices and methods.
  • Knowledge of the AHCCCS benefits eligibility requirements and enrollment procedures.
  • Knowledge of the Medicare enrollment and eligibility requirements.
  • Knowledge of the Federal Marketplace eligibility and enrollment requirements.
  • Knowledge of customer service principles.
  • Knowledge of the SRPMIC Per Capita and land lease disbursements.
  • Knowledge of HIPAA compliance standards.

  • Skill with accurate and timely record-keeping plus accessing and retrieving database information.
  • Skill maintaining accurate client benefits information and files.
  • Skill establishing and maintaining effective working relationships at all levels of the organization and with outside benefits partners.
  • Skill researching a variety of information and problems pertaining to benefit matters.
  • Skill with a personal computer including MS Office and MAISE software. Proficiency with MS Excel spreadsheets is critical.
  • Skill with verbal and written communication and interpersonal skills.
  • Skill working with minimal supervision.

  • Ability to use creative marketing strategies to maximize Community outreach.
  • Ability to meet with clients to patiently, easily but thoroughly explain the benefits program and processes.
  • Ability to interact effectively as a team member with management and line staff.
  • Ability to be a self-starter and manage time and workflow efficiently.
  • Ability to perform detailed work for prolonged periods.
  • Ability to use discretion and judgment when dealing with client and program confidential information.
  • Demonstrates ability to manage and resolve work related problems.


Minimum Qualifications

Education Bachelor's degree from an accredited college or university is preferred.
  • Certified Benefits Professional (CBP) highly preferred.
  • Certified HEAplus Assistor
  • Certified Application Counselor with the Federal Marketplace
  • Certified State Health Insurance Program (SHIP) form Intertribal Council of Arizona


Experience: Five (5) years healthcare industry benefits administration experience preferred but not required.
  • Demonstrated successful experience with accurate data entry and report generation required.
  • Demonstrate ability to manage and resolve problems.
  • MS Office proficiency, with an emphasis on MS Excel, required.
  • AHCCCS, Medicare, the Affordable Care, & Social Security related experience highly preferred.
  • Benefits related experience with low income population highly preferred.
  • Experience working with SRPMIC Community Members, highly preferred.
  • Knowledge of Software/programs to verify insurance such as AHCCCS online, Change Healthcare.
  • Experience in working with diverse populations.


Equivalency: Any equivalent combination of education and/or experience that would allow the candidate to satisfactorily perform the duties of this position, will be considered.

Underfill Eligibility: An enrolled Community Member whom closely qualifies for the minimum qualifications for a position may be considered for employment under SRPMIC Policy 2-19, Underfill.

Special Requirements

  • May be required to work outside normal work hours including nights, weekends and holidays.
  • Employees in, and applicants applying for, jobs providing direct services to children are subject to the "Community Code of Ordinances", Chapter 11, "Minors", Article X. "Investigation of Persons Working With Children".

Prior to hire as an employee, applicants will be subject to drug and alcohol testing. Will be required to pass a pre-employment background/fingerprint check.

"SRPMIC is an Equal Opportunity/Affirmative Action Employer" Preference will be given to a qualified: Community Member Veteran, Community Member, Spouse of Community Member, qualified Native American, and then other qualified candidate.

In order to obtain preference, the following is required: 1) Qualified Community Member Veteran (DD-214) will be required at the time of application submission 2) Qualified Community Member (must provide Tribal I.D at time of application submission),3) Spouse of a Community Member (Marriage License/certificate and spouse Tribal ID or CIB is required at time of application submission), and 4) Native American (Tribal ID or CIB required at time of application submission).
Documents may be submitted by one of the following methods:
1) attach to application
2) fax (480) 362-5860
3) mail or hand deliver to Human Resources.
Documentation must be received by position closing date.
The IHS/BIA Form-4432 is not accepted .
Your Tribal ID/CIB must be submitted to HR-Recruitment-Two Waters.

Benefits:

The SRPMIC offers a comprehensive benefit package including medical, dental, vision, life, disability insurance, and a 401(k) retirement plan. In addition employees enjoy vacation and sick leave and 13 paid holidays.
08abc044a6c4197ff14da6300120074b