Health Benefits Coordinator
3 months ago
The Position
Reporting to the Health Manager, the Health Benefits Coordinator adjudicates and processes Health Benefits decisions and payments for eligible First Nations community members and service providers. Health Benefits include Pharmacy, Medical Supplies and equipment, Vision, Mental Health Crisis Intervention, Dental care, and Medical Transportation.
The Candidate:
Health Benefits Administration
- Assist community members in accessing health benefits from various partners, including Pacific Blue Cross, NIHB, Plan W, FNHA, Jordan’s Principle and process applications as needed.
- Review, assess and adjudicate requests (prior approvals, amendments, post approvals and client reimbursements), ensuring compliance with Nation Policy.
- Support MSP applications, including new MSP applications.
- Assist with accessing Nation benefits – such as health special needs and medical transportation.
- Receive, approve and process Nation benefits through the health special needs program per Nation policies & procedures.
- Support accessing federal/provincial benefits (disability tax credit).
- Work on exceptions and the appeals process with PBC and FNHA.
- Keep apprised of changes to health benefits administration programs, eligibility and qualification criteria.
Care Coordination and Collaboration
- Liaise with service delivery providers, including FNHA, PBC and the Province of BC.
- Liaise with local health care providers, physicians, pharmacies, long-term care facilities, physiotherapists, dentists, vision, and medical equipment vendors.
- Interact with service providers and health care professionals to exchange information about prior approval requests, Nation policy, client files and benefit eligibility.
- Work collaboratively with Home Health Liaison, home care nursing, home support and medical transportation teams.
- Participation in working groups, meetings, and information sessions internally or with external groups.
General, Administration and Reporting
- Screen requests for completeness and accuracy, clarify and obtain information, and explain requirements, procedures, rights, and obligations regarding claims and eligibility for benefits to clients, stakeholders, and service providers.
- Verify and process financial transactions, identify and correct transactions for services rendered with respect to accuracy, client and recipient eligibility, and cost verification in preparation for payment in accordance with the Nation's financial policies, and answer provider and client inquiries.
- Using accounting software to maintain financial records and process financial requests.
- Comfortable using database software such as the Nation databases to document client interactions and process financial information.
- Excellent verbal and written communication skills, communicates effectively and sensitively with clients from diverse backgrounds, including conflict resolution.
- Maintain flexibility in schedule and respond to unexpected emergencies and changes in workload to fulfill responsibilities.
- Attend and participate in scheduled staff and client care meetings as requested.
- Perform other tasks within the scope of the position.
Qualifications, Skills and Abilities:
- A secondary school diploma or employer-approved alternatives or an acceptable combination of education, training, and/ or experience.
- Three (3) years of benefits Administration, preferably within a First Nations environment.
- Experience working with various office systems and equipment.
- Experience working with indigenous people, organizations and communities.
- Time management and organizational skills, techniques, and practices are required to use time effectively, cope with conflicting or changing priorities and maintain established service standards.
- Excellent verbal and written communication skills.
- Communicate effectively and sensitively with clients from diverse backgrounds, including conflict resolution.
- Analytical skills, sound judgement, and decision-making skills to assess situations and determine the best possible outcomes.
- Able to submit an acceptable Criminal Records Check before the start date.
- A valid BC license and access to a reliable car.
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