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Health Benefits Assessor
3 months ago
FNHA Overview:
The First Nations Health Authority is a diverse and transformational health organization of professional, innovative and dedicated team members and leaders.
The first of its kind in Canada, FNHA works as a health-and-wellness partner with BC First Nations to support self-determination and decision-making to improve health outcomes.
JOIN OUR HISTORIC JOURNEY
At FNHA, you'll have the opportunity to contribute to BC's history.
With a unique governing structure and mandate, our fluid work environment means you can play an active role in real change.
Our talented teams value respect and foster lateral kindness in their working relationships. Our holistic approach to wellness, based on First Nations teachings, is incorporated into all aspects of work culture. Where else will you get to create a personal wellness plan as part of your performance goals?Position Summary:
The Health Benefits Assessor reviews, assesses, and adjudicates First Nations Health Benefits requests. Processes payments and client reimbursements. Conducts analysis and provides recommendations regarding exceptions and appeals. Provides program information to key stakeholders. Maintains records and systems.
Union Code - PSA (Public Service Alliance of Cda)
Hours per week - 37.5
As a health and wellness organization, the First Nations Health Authority has aligned with the Provincial Public Health Order released on October 14, 2021. We have a mandatory COVID-19 vaccination policy for all employees at First Nations Health Authority. This policy requires all employees to be fully vaccinated against COVID-19. If selected for employment, you will be required to provide proof of vaccination by providing a copy of your BC Vaccination Card Passport with the QR code.
Responsibilities:
- Reviews, assesses, and adjudicates FNHA Health Benefit requests including prior approvals, amendments, post approvals, invoices and client reimbursements. Screens requests for completeness and accuracy. Clarifies and obtains required information, and explains requirements, procedures, rights, and obligations regarding claims and eligibility for benefits to clients, and stakeholders.
- Inputs adjudicated benefit decisions into an online Claims Processing system or alternate, including other related databases and spreadsheets. Performs patient, benefit, and cost verification to maintain integrity of client history in the databases.
- Provides FNHA Health Benefits information, advice, and assistance via telephone and/or written communication with First Nation clients, organizations, providers, prescribers and other stakeholders relating to client and benefit eligibility, benefit criteria, prior approval, and appeal processes and payments.
- Maintains and update databases, client files, and management and document control of electronic images and files.
- Maintains control accessibility of confidential client files and FNHA financial records to ensure privacy and security. Ensures client files are complete and includes documents such as specialist assessments, observations, research, recommendations, cost estimates and alternatives, and diagnoses. Researches, extracts and compiles data and/or information to respond to client, supplier, health agency, and staff enquiries as required.
- Provides analysis, advice, and recommendations to the Manager regarding benefit requests, review outcomes, exceptions, and appeal requests as required. Forwards and/or consults with Review Centre or consultant regarding complex requests for review and recommendation, such as approval or denial, as required.
- A full job description is available upon request._
Qualifications:
Education, Training and Experience:
- Grade 12, including completion of one year of postsecondary education, plus one (1) year of related experience, or an equivalent combination of education, training, and experience.
Knowledge, Skills & Attributes:
- Knowledge of First Nations social, health, economic, and political issues
- Ability to provide information and advice directly to clients and providers.
- Conflict resolution skills.
- Time management skills.
- Knowledge of medical terminology
- Knowledge of data entry, manipulation, and retrieval techniques using a variety of automated systems and software.
- Physical ability to perform the duties of the position
Closing Statement:
Diversity
The First Nations Health Authority is committed to respecting diversity within our workforce; preference will be given to individuals with Indigenous ancestry (First Nations, Inuit, Métis).
What You Can Expect From Us
Joining our family means joining an organization that supports personal growth, in-house training, a paid volunteer day and a unique full-day orientation program.
