Live In Insurance Tpa Jobs in Oregon (NOW HIRING)

Salary Pay Range:$24.60/hr.-$31.84/hr.

Essential Functions:

• Collects patient insurance benefits information, coverage, eligibility, primary care provider, co-payment amounts, and scans insurance cards into Electronic Patient Management system (EPM).
• Coordinates eligibility of benefits with the tribe’s third-party payer (TPA), Purchased Referred Care, and the Skookum Health Assistance program staff.
• Limited scheduling and checking in patients.
• Determines Patient out of pocket, collects money and provides receipts to patients for copayments, and payments on account for all GRHWC departments.
• Gathers eligibility information for all American Indian/Alaska Natives (AI/AN) receiving health care for all GRHWC programs. Includes collection of documentation, contacting other tribes.
• Ensures that Tribal affiliation meet requirements of Federal guidelines for services.
• Collects all necessary documentation from patients to determine eligibility for services available to
• pregnant women of PRC eligible fathers, i.e. birth certificates, certificate of Indian blood, Tribal
• ID cards, marriage certificates or paternity statements.
• Acts as a liaison between the individual, insurance, and the billing department.
• Processes new patient paperwork, obtains appropriate signatures, pertinent patient and

insurance information, as well as waivers.

• Balances cash and receipts to the cash register daily. Assists with running end of month reports to report to Billing.
• Posts payments into the EPM, into patient accounts daily.
• Timely and accurately enters all updated patient demographics, insurance/alternate resource

information into the EPM. Also, assists in ensuring all new patient packets are completed and entered prior to receiving services.

• Updates address changes in EPM from various departments such as Enrollment, ICW, and
• Pharmacy.
• Assists patients with sign up and maintain accurate information within the patient portal.
• Follows emergency code calling protocol for emergencies entering the HWC.
• Reviews correspondence and eligibility letters for direct care and PRC members; provides information on how to access services.
• Alerts account notes for Clinic staff. Follows appropriate procedures for patients with account alerts.
• Provides Patient Registration reports as requested.
• Provides general information regarding services available to the community.
• Authorized to transport native and/or non-native patients of the GRHWC in company vehicle as necessary.
• Performs a variety of other duties as assigned by supervisor.

 Education, Experience, and Licenses:

• Requires a high school diploma or GED and a minimum two (2) years of post-high school specialized job skills training in the medical billing, accounting principles or other closely related accounts receivable/payable field.
• OR equivalent combination of education, training and experience.

 Driving Requirements:

• Must maintain a valid Oregon driver’s license or obtain one upon hire, qualify for the Tribe’s vehicle insurance, and provide proof of personal vehicle insurance.

Qualifications, Registrations, and Certifications:

• Requires knowledge of accounting principles and practices.
• Knowledge of ethical and legal requirements and restrictions pertaining to the maintenance of medical records, as well as facility policies, HIPAA and other federal regulations.
• Requires knowledge of electronic patient management system (EPM) and standard office equipment such as fax machine, copy machine, visa machine, 10 key, and multi-line telephone.
• Requires knowledge of Windows based PC system, or comparable.
• Knowledge of and sensitivity to Native American culture is required.

 Environmental Factors and Conditions/Physical Requirements:

• Continually requires the ability to express or receive detailed information or important instructions through oral communication.
• Continually requires working with fingers rather than the whole hand or arm. Requires repetitive movement of wrists, hands and/or fingers. Often requires walking or moving about to accomplish tasks.
• Requires standing and/or sitting for sustained periods of time, raising objects from a lower to a higher position and/or moving objects horizontally.
• Occasionally requires lifting of up to 20 pounds.
• This position is frequently subject to inside environmental conditions which provide protection from weather conditions, but not necessarily from temperature changes, and is occasionally subject to outside environmental conditions.

• Supports a safe work environment by performing all duties in accordance with Tribal safety policies and procedures, and Emergency Management Plan. 

• Due to the nature of the interactions with other employees and the public we serve, employees may be required to provide documentation of, or receive, certain health vaccinations.
• May be called upon to serve as a Disaster Reservist during emergencies.
• Local travel is occasionally required. Travel outside of the state is infrequently required.

 Background Check:

• Candidates for this position will be subject to criminal and character background checks and may be subject to fingerprinting.