BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS

CHIEF BALCKBIRD   CENTER                                     P.O. BOX 39                                                  ODANAH,   WI 54861

Job Title:                    Assistant Billing Office/PRC Manager                                           

Hours                          Full Time-40

Department:              Clinic

Hourly Rate:              $15-16/hr DOQ

Exempt:                      No/Hourly

Supervisor:                 Billing Office/PRC Manager

Summary: This position is responsible for assisting the Billing Office/PRC manager in the daily function of the billing /PRC department. Will assist the Billing Office/PRC manager in supervising billing clerks, reception staff, medical coder and health information staff in duties directly related to medical billing or PRC funds. The assistant is also expected to function in the role of billing clerk or PRC specialist as needed to support departmental efficiency.

Essential Duties and Responsibilities including the following. Other duties may be assigned by the Billing Office/PRC manager as necessary.

Oversees daily office operations and delegates duties to assigned staff in the absence of the Billing Office/PRC Manager..

Assist staff in understanding, implementing, maintaining and updating clinic policies and procedures related to billing and PRC.

Prepares and submits any and all reports as required and requested by manager.

Assists Billing Office/PRC Manager in developing guidelines for prioritizing work activities, evaluating effectiveness, and modifying activities as necessary.

Ensures business office, PRC and reception is appropriately staffed in the absence of the manager.

Helps staff establish deadlines for work assignments and completion.

Assists manager in identifying, analyzing, and resolving work problems.

Maintains strict confidentiality and ensures that requests for information are handled promptly and effectively.

Enforces and monitors HIPAA requirements for the health department.

Works with other managers to ensure all efforts are coordinated and high quality patient care is provided.

Participate in professional development activities.

Proficiency on billing, RPMS and scheduling systems. Must be familiar with the electronic health record also. Assist with computer training and troubleshooting programs when possible.

Specific Billing Office responsibilities:

Process claims for Medicaid, Medicare and third party payers.

Reconcile claims within an appropriate amount of time.

Assists manager to maintain data on all billing activities. Uses data to evaluate billing processes, payer mix and revenue sources.

Reconciling checks with insurance remittances

Periodically audits billing processes to ensure accurate coding and documentation.

Communicate with insurance companies to resolve payment or credentialing issues.

Knowledge of billing clearing house systems for billing.

Specific Purchased Referred Care (PRC) responsibilities:

               Maintains all documentation necessary for eligibility requirements of PRC funding.

               Ensures all federal regulations are met with application process and disbursement of PRC funding.

               Assures the timely and correct preparation of PRC authorization forms utilized to obligate funds.

               Enforces tribal and federal guidelines for PRC.

               Ensures prompt payment and accounting of PRC expenses.

               Assists the Billing Office/PRC Manager and other healthcare supervisors in determining priorities for patient services.

Performs periodic spot reviews, audits completed application forms, and other documents to ensure consistent and correct use of PRC funds.

Assists community members with medical coverage questions or concerns when appropriate.

Serves as liaison between PRC and outside providers to provide quality services for the Bad River community.

Specific Reception Supervisor responsibilities:

Assists manager with coordinating patient information collection to minimize redundancy and support all departmental needs.

Facilitates communication between reception staff and Medical Benefits staff to assist patients in obtaining medical coverage.

Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative to the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:

Required:

High school diploma or GED.

Associates degree in Medical Office Administration and/or related field or minimum of five years of work experience in a related position processing or preparing claims for insurance payment.

Knowledge of third party alternate health care and social service resources, such as supplementary security income, Medicare, private insurance.

Knowledge of these programs eligibility requirements, referral and appeal procedures, billing and payment policies to assure maximum utilization of third party reimbursement and alternate resources.

Knowledge of PRC regulations, policies, and procedures, third party billing standards, policies and procedures to operate the program effectively and efficiently.

Knowledge of IHS automated data processing systems, such as financial management reports Purchased Referred Care reports, Contract Health Service Management Information System, patient registration (RPMS) and M/M eligibility file system, and operational functions of a personal computer to develop data.

Preferred:

Course in medical terminology and health care office management.

Knowledge of clinic office procedures.

Coding certification

Other Skills and Abilities:

Required:

This is a required driver position.

Must possess a valid Wisconsin driver’s license and meet eligibility for tribal insurance.

Knowledge of organizational policies, procedures and systems.

Attention to detail, efficient and organized.

Excellent customer service skills

Excellent computer skills

Willingness to attend training on coding and other billing processes Must be willing to travel if necessary.

Must be willing to pursue educational opportunities regularly to stay abreast of changes in healthcare system that effect billing and PRC services.

Due to the nature of this position excellent attendance and punctuality is a requirement.

Background Check:

This position is contingent on ability to pass background check required. This position for eligibility a Caregiver Background Check regarding working with children and/or elderly and required driver check, to meet eligibility for Tribal Insurance.

Language:

This individual must communicate clearly and effectively.

Analytical skills regarding work flow and financial matter are helpful.

Excellent knowledge of computer systems and applications.

Must possess excellent oral and written communication skills.

Reasoning:

Must be able to set priorities among multiple requests.

Must be able to recognize accept and properly access channels of authority and supervision.

Must possess the ability to work as a project leader and be people oriented.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Position may require prolonged periods of walking, standing, bending, stooping, and/or occasional lifting up to 25lbs.

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

Drug-Free Workplace in accordance with the Drug Free Workplace Act of 1988, P.L. 100-690 and the Bad River Tribe’s Employee Policy & Procedures Handbook. Indian Preference will be give in accordance with P.L. 93-638 and the Tribe’s Preference Policy.

PUBLIC:

Opens: July 20th, 2017

Closes: Open till filled.

                                                                                                                        Send Application and Resume To:

                                                                                                                                       Bad River Tribe

                                                                                                                                       Attn: Personnel

                                                                                                                                       P.O. Box 39

                                                                                                                                       Odanah,   WI   54861