• The Patient Account Representative is responsible for working accounts to ensure they are resolved in a timely manner. • Representative will need to effectively follow-up on claim submission, remittance review for insurance collections, create and pursue disputed balances from both government and non-government entities. • Document clear and concise notes in the patient accounting system regarding claim status and any actions taken on an account. • Maintain department daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership.

Role Description The Member Services Representative (MSREP), reporting to the Member Services Manager, is responsible for the verification of insurance eligibility for new and existing patients receiving clinical services within the health center. This includes collection of basic necessary demographic information to initiate the enrollment process and to assess their financial and payer source status. As part of the clerical/administration process, they will determine eligibility for public insurance programs, and obtain verification of private insurance as it relates to the patient encounter. This position has the flexibility to be an onsite position or a work-from-home position, per our telecommuting policy. Essential Functions: - Handles new patient registration as well as assisting patients in a face-to-face setting which involves creating demographic charts in the Electronic Health Record (EHR) software for members coming to utilize clinical services as well as eligibility inquiries for established patients. - Provides support to patients regarding Medi-Cal, Medicare and their managed care systems in a clear and professional manner that ensures their understanding. - Utilizes the Electronic Health Record (EHR) RTS system and/or individual payer websites to obtain eligibility and/or pre-authorization information for next day appointments. - Refers patients to Certified Enrollment Counselors for enrollment and re-enrollment of Medicaid, Affordable Care Act (ACA), and other state and federal programs. - Confirms SNAHC is the assigned Primary Care Physician (PCP) with patient insurance plans. - Notifies appropriate patients of any eligibility conflicts, outstanding balances and/or out-of-pocket costs associated with visits. - Ensures all information entered into the Electronic Health Record (EHR) is accurate and complete. This includes reviewing and verifying any paper documents to make sure that all forms are completed, identified, signed and corrected. - Completes required data entry as it relates to insurance eligibility prior to any services by any provider, must be able to complete this task efficiently and effectively. - Verifies patients have updated their consents, signature forms and demographic information within the last 12 months, and communicate this in accordance to the process. - Complies with all state and federal laws and regulations, as they pertain to position including; HIPAA, sexual harassment, Scope of Practice, OSHA, etc. - Other duties assigned. Skills and Abilities: - Familiarity with working closely with patients, providing guidance and solutions to complex concerns. - Familiarity with individual payer guidelines. - Demonstrated ability to provide excellent customer services to patients. - Competency in executing assessments of patients needs, to provide efficient care and service. Competencies: - Communication and Relationships - Initiative - Planning and Organizing - Safety - Teamwork - Customer Service - Data Collection - Eligibility - Scheduling Qualifications - Must have 1+ year(s) of knowledge and experience working in a clinical front office setting. - High School diploma or GED. - Knowledge and/or familiarity of Medicare; Medi-Cal; Presumptive Eligibility; local Geographic Managed Care Plans (GMC); state/federal funded programs for health care enrollment; Sliding Scale. - Ability to demonstrate superior professionalism when working with clients, staff, and vendors. Preferred Qualifications - NextGen Experience. - Bilingual. - Excellent computer skills, preferably with Windows. - Knowledge of traditional, cultural, and spiritual practices of the diverse AI/AN community, as well as ability to work with other racially, culturally ethnically, and financially diverse populations. Notes Please Note: This position may be grant funded. Continued employment is contingent upon renewed or additional funding and may be discontinued at the close of the grant cycle. Grant funding for any position does not impart any contractual right, either expressed or implied, to remain in Sacramento Native American Health Center, Inc.’s employment for a specific period of time. Grant funding does not affect the Sacramento Native American Health Center, Inc.’s status as an “at will” employer.

• Perform specialized patient access functions requiring an advanced understanding of insurance benefits and processes • Communicate with Payers, Pharma, Physicians, and Patients • Recognize trends, identify and clarify patients’ needs, and work towards solutions • Facilitate cross-functional resolution of drug coverage issues & proactively address, research & resolve issues impacting referral turn-around time • Independently resolve basic patient claims issues using key subject matter knowledge • Prepare and review claims to ensure accuracy to payer requirements, including codes, dates, and authorizations • Collaborate with internal departments to resolve issues or provide information

Role Description The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an appeal, grievance, or further request is warranted. The representative delivers a final determination based on trained skillsets or partnerships with clinical and other Humana parties. This role performs advanced administrative, operational, and customer support tasks that require independent initiative and judgment. - Assists members, by phone or face-to-face, to support quality-related goals. - Investigates and resolves member and practitioner issues. - Exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes, and techniques. Qualifications - 1 - 3 years of customer service experience. - Less than 2 years of leadership experience. - Experience in the healthcare industry or medical field. - Experience in a production-driven environment. - Previous experience in the healthcare or medical fields. - Data entry skills. - Intermediate experience with Microsoft Word and Excel. - Flexible hours based on needs to work possible overtime. Requirements - Associate or bachelor's Degree (preferred). - Inbound call center or related customer service experience (preferred). - 1+ years of experience (preferred). - Experience processing medical claims (preferred). - Bilingual (English and Spanish); with the ability to read, write, and speak both languages (preferred). - Experience with Medicare (preferred). - Experience with the Claims Administration System (CAS) (preferred). - Knowledge of medical terminology (preferred). - Manage large volume of documents including tracking, copying, faxing, and scanning (preferred). Benefits - Medical, dental, and vision benefits. - 401(k) retirement savings plan. - Time off (including paid time off, company and personal holidays, paid parental and caregiver leave). - Short-term and long-term disability. - Life insurance. - Many other opportunities to support whole-person well-being. Additional Information - Workstyle: Remote Nationwide. - Interview Format: Use of HireVue technology for interviews. - Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. - Occasional travel to Humana's offices for training or meetings may be required. - Scheduled Weekly Hours: 40. - Pay Range: $43,000 - $56,200 per year.