JOB TYPE: Full Time
LOCATION: Circle of Health
REPORTS TO: Circle of Health Benefits Manager
SALARY RANGE: $32,921 - $65,286

Any individual who receives an offer of employment or will receive a payroll check are required to submit to a drug and alcohol test as a condition of obtaining employment.
Mille Lacs Band Member/American Indian preference applies

SUMMARY:
Circle of Health was developed to assist with premiums, copays, and deductibles for the Mille Lacs band of Ojibwe Band members and the prospective families. This position is responsible for assisting people with health benefit application; educating people of their health benefit for which they are eligible and navigating additional community resources to facilitate the application process. This position is responsible to case manage groups of people who need additional assistance with acquiring health insurance coverage; such as Medicare, Medical Assistance, and private or employer plans. This position will be responsible to assist Claims Processors with denials and follow-up of any claims/requests.

QUALIFICATIONS:
• Two years of post-secondary education is required.
• One to three years of experience health insurance billing or claims experience.
• Knowledge of Medicare, Medicaid, and private insurance eligibility requirements.
• Basic computing skills in a Windows environment, including Word and spreadsheet software.
• Strong written and verbal communication skills; ability to work as part of a team.
• Knowledge of third party resources and eligibility criteria.
• Knowledge of community resources and/or Minnesota health care programs.
• Skill in handling multiple complex and simultaneous tasks while recognizing priorities and meeting deadlines, and attention to details.
• Ability to work and communicate sensitively, confidentially, and effectively with Band members, families, public agencies and co-workers.
• Ability to work independently with little or no supervision is required.
• Knowledge of Data Privacy Act, HIPAA and ability to maintain strict confidentiality of Band member, provider, and Band information.
• Experience in and sensitivity to Native American culture.
• Ability to understand and follow directions.
• Must have a valid current driver’s license.
• Must be insurable under the Mille Lacs Band Driver’s insurance policy.
• Must be able to pass a pre-employment drug and alcohol test.
• Must pass a background check for Mille Lacs Band and MNsure Health Insurance Exchange.

DUTIES AND RESPONSIBILITIES:
• Serves as a resource for MNsure within the department; may act as a liaison between tribe, county and state.
• Assists clients in understanding and applying for applicable third party benefits, such as Medical Assistance, Medicare, employer and private plans.
• Apply program knowledge and experience to identify, document and problem solve conversion and enrollment issues and problems.
• Determine client eligibility for multiple federal, state and local public assistance programs;
• Use tribe and state computer systems to access client data, enter and process data for benefits; access manuals, guides and other policy/program related resources.
• Communicate complex program requirements, expectations, and timeframes to a diverse range of clients in person, over the phone and in writing; communicate eligibility determinations and explain program guidelines to clients; refer clients to additional community resources as appropriate
• Share responsibility of a pooled caseload with team members
• Understand, coordinate and navigate the MNsure Health Insurance Exchange to assist clients with enrollment
• Understand the Circle of Health and Patient Referred Care Services (formerly Contract Health Services) programs
• Visit clients in homes to collect information and enroll patients in health benefits
• Transport clients to various agencies to resolve third party, social security, or billing issues.
• Maintain an up-to-date listing of various community resources and agency health education materials
• Assist other employees, both within and outside the team, to help assure excellent client services.
• Promote, educate and provide outreach to clients regarding State Health Care Plans, private pay plans, Medicare, Circle of Health program and services at community events, health fairs, various meetings, etc.
• Coordinates with claims processors with Circle of Health to identify denial letters to be sent out.
• Assists with Band mailings.
• Create denial letters and maintains all denial correspondence on the ACT system.
• Maintains monthly log of denials, to present to COH Director
• Process and claims from Mille Lacs Band of Ojibwe employers, as necessary.
• Process pharmacy and clinic claims, as necessary.
• In the absence of Claims Processors, will process claims
• Performs other duties as deemed appropriate by Health Benefit Administrator

WORKING CONDITIONS:
• Nature of work is such that incumbent experiences infrequent periods of moderate stress levels while dealing with band members, families, and others.
• Work is exclusively indoors in a controlled climate area.
• Little threat of personal danger or risk.
• Hours are typically 8-5, but possibly with some extra hours. May involve some evening or weekend work.
• Local travel is required.
• Work from home may be permissible with a signed telework agreement.