You strongly believe in providing an exceptional customer experience in a professional and friendly manner. You are a detail oriented individual and an excellent problem solver who can remain calm while working under pressure. If this sounds like you, we would like to hear from you!
You will review, assess and adjudicate Health Benefit requests, process payments and client reimbursements, and maintain records. You will also conduct analysis and provide recommendations regarding exceptions and appeals, as well as provide program information to key stakeholders.
1. 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.
2. Inputs adjudicated benefit decisions into an on-line 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.
3. 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.
4. Maintains and update databases, client files, and management and document control of electronic images and files.
5. 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.
6. 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.
7. Performs other related duties as assigned.
Education, Training and Experience:
-Grade 12, including completion of one year of post-secondary education, plus one (1) year of related experience, or an equivalent combination of education, training, and experience.
Job Skills and Abilities:
-Knowledge of First Nations social, health, economic, and political issues Ability to provide information and advice directly to clients and providers.
-Ability to use computer applications such as Microsoft Word and Excel. 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.
Employee Class: Temporary
Application Deadline: December 13, 2018 at 4:00 pm