Medical Billing & Claims Manager (DHPI98)
Company: Tuba City Regional Health
Location: Tuba City
Posted on: May 19, 2023
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Job Description:
In accordance with Navajo Nation and federal law, TCRHCC has
implemented an Affirmative Action Plan pursuant to the Navajo
Preference in Employment Act. Pursuant to this Plan and
corresponding TCRHCC Policy, applicants who meet the necessary
qualifications for this position and (1) are enrolled members of
the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe
will be given preference in hiring and employment for this
position, (2) are legally married to enrolled members of the Navajo
Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet
residency requirements will be given secondary preference, and (3)
are enrolled members of other federally-recognized American Indian
Tribes will be given tertiary preference.POSITION SUMMARYThe
purpose of the position is to manage and lead the medical, pharmacy
and dental billing of third-party payers applicable to outpatient,
inpatient, ancillary, ambulatory surgery and professional services.
Incumbent is responsible for management, providing technical
direction and submission of properly executed claims in a timely
manner to third party payers, responsible parties, and resubmission
of corrected claims. Maximize reimbursement and minimize denied
payments. Understand and monitor Patient Financial Key Performance
Indicators while achieving the Clean Claim Goal established for
TCRHCC. Responsibilities will also include delegation and
assistance to the Director of Revenue Cycle.NECESSARY
QUALIFICATIONSEducation:Associate degree in Business Administration
or related business field (Finance, Accounting, Administration,
etc.)Experience:Minimum three-years of successful supervisory or
management Minimum five-year experience as a medical billing
technician in a tribal or non-profit healthcare patient accounting
Demonstrated knowledge of ICD-10, and CPT/HCPCS coding/billing
procedures, Uniform Hospital Discharge Data definitions regarding
diagnostic and procedural sequencing in order to interpret and
resolve problems based on information derived from system
monitoring reports and the UB-04, HCFA-1500, and ADA billing forms
submitted to the third-party Computer skills: ability to access and
use multiple data License/Certification:Obtain a Certification as a
Revenue Cycle Representative through the Healthcare Financial
Management Association (HFMA) one year from date of hire. Failure
to obtain certification will result in termination of employment at
TCRHCC.Other Skills and Abilities:A record of satisfactory
performance in all prior and current employment as evidenced by
positive employment references from previous and current employers.
All employment references must address and indicate success in each
one of the following areas:Positive working relationships with
othersPossession of high ethical standards and no history of
complaintsReliable and dependable; reports to work as scheduled
without excessive absences and no reported attendance issuesAbility
to plan and lead effective team meetings and trainingPossess
expertise in professional communication, interpersonal,
organizational leadership and team building skillsPossess excellent
customer services skills for internal and external customersAbility
to work under pressure and making quality and effective
decisionsAbility to positively motivate individuals and teams to
meet or exceed department expectations/goals.Completion of and
above-satisfactory scores on all job interviews, demonstrating to
the satisfaction of the interviewees and TCRHCC that the applicant
can perform the essential functions of the jobSuccessful completion
of and positive results from all background and reference checks,
including positive employment references from authorized
representatives of past and current employers demonstrating to the
satisfaction of TCRHCC a record of satisfactory performance and
that the applicant can perform the essential functions of the
jobSuccessful completion of fingerprint clearance requirements,
physical examinations, and other screenings indicating that the
applicant is qualified to be employed by TCRHCC and demonstrating
to the satisfaction of TCRHCC that the applicant can perform the
essential functions of the jobSubmission of all required
employment-related documents, applications, resumes, references,
and other required information free of false, misleading or
incomplete information, as determined byMENTAL AND PHYSICAL
EFFORTThe physical and mental demands described here are
representative of those that must be met by an employee to
successfully perform the essential functions of this job.
Reasonable accommodation may be made to enable individuals with
disabilities to perform the essential functions.Physical:The work
is primarily sedentary, must have ability to sit for a prolonged
period of time, and occasionally stand, walk, drive, bend, climb,
kneel, crouch, twist, maintain balance, and reach. Must have
ability to lift, push and pull over 100lbs occasionally. Sensory
Requirements for position include prolonged telephone use, frequent
far, near and color vision, depth perception, seeing fine details,
hearing normal speech, and hearing overhead pages. Must have
ability of both hand manipulation in prolonged use of keyboards,
and frequent simple/firm grasping and fine
manipulation.Mental:Exercises initiative and judgment in deviating
from existing department or corporation practices to resolve
billing issues/concerns. Work is reviewed for conformance to
policies, procedures, and practices relating to billing practices.
Must have ability of prolonged concentration and to work alone,
frequent ability to cope with high levels of stress, make decisions
under high pressure, handle multiple priorities in stressful
situation, demonstrate high degree of patience, adapt to shift
work, work in areas that are close and crowded, and occasionally
cope with anger/fear/hostility of others in a calm way, manage
altercations, and handle a high degree of flexibility including
frequently accepting a flexible schedule to meet unit
needs.Environmental:May occasionally be exposed to infectious
disease, chemical agents, dust, fumes, gases, extremes in
temperature or humidity, hazardous or moving equipment, unprotected
heights, and loud noises.ESSENTIAL FUNCTIONS:Manages and leads the
billing functions and staff in the medical (Institutional &
Professional), Pharmacy and Dental, billing and Thorough knowledge
of third-party payer rules and regulations (i.e. Medicare,
Medicaid, Managed Care, Commercial Insurance, Workers'
Compensation, Motor Vehicle Insurance)Experienced with charge
master, EDI claims, medical billing, E.H.R., CCI Edits and Claims
Scrubbing, and Insurance Verification of Benefits systems.Develops,
implements and maintains billing policies and Establishes and
maintains a working relationship with Medicare and Medicaid
intermediaries, state and federal agencies, area employers and
private insurance Proficient with MS Excel and Word software
Develops statistical reports and control methods, which identify
insurer billing requirements, and productivity standards and
results. Identifies limitations and provides information for staff
Provides technical assistance to management, medical providers,
patients and other facility personnel by obtaining information
relative to medical billing requirements, covered services, audit
reports, or billing statistics, Coordinates and oversees work of
staff; has the responsibility of distributing workloads as
Responsible for maintaining time and attendance in timekeeping
system of Monitors productivity of staff to ensure it meets
production Assures staff is provided a work environment conducive
to productivity and good health.Trains employees and holds periodic
(in-house) training sessions. Assists in interpreting regulations,
requirements and procedures; provides technical assistance to
resolve patient accounting system Reviews staff work for
conformance to policies, procedures, and practices relating to
Alternate Resources regulations, review of appropriate E&M,
correct CPT/HCPCS codes, American Medical Association (AMA)
requirements, American Dental Association (CDT-2), and the Health
Care Finance Administration (HCFA) Prepares and conducts employee
job performance evaluations and forwards to Director of Revenue
Cycle for Responsible for the orientation and education of staff to
ensure compliance with new and existing regulations of third party
payers (i.e. covered services, limitations, ).Assists with testing
of new software, implementation of new payer requirements and
guidelines, CMS regulatory guidelines, new process flows, Evaluates
and addresses issues and concerns relative to daily operations of
assigned areas, also provides recommendation/suggestion to improve
the overall operations (i.e. cost containment via personnel
management) to the Director of Revenue CycleResponsible to
initiate, carry out, and enforce disciplinary action policy and
procedure with staff when Verifies accuracy of services and billed
amounts, and that services are allowed by appropriate regulations,
directives and payer guidelines.Identifies errors, omissions,
duplications in documents and contacts the appropriate individuals
to resolve Responsible for providing monthly reports, organizing
schedules (i.e. regular, overtime, ).Attends and participates in
management meetings as Accepts delegation in the absence of
immediate Ensure proper PPE is always worn while on duty including
but not limited to, face mask, gloves, gown, isolation gown, NIOSH-
approved N95 filtering facepiece respirator or higher, if
available), and eye or face Complete all donning and doffing tasks
in a safe acceptable method and discard of used PPE (see CDC
website for most current updates)Complete task training for all
routine cleaning and decontamination processes for all surfaces
contaminated by a communicable disease to ensure a high level of
patient, visitor, employee, and external customer Performs other
duties and special projects as assigned or required.
Keywords: Tuba City Regional Health, Saint George , Medical Billing & Claims Manager (DHPI98), Accounting, Auditing , Tuba City, Utah
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