Closing Date: Open until filled. Salary Range: $15.45 to $18.24/hour**APPLICANT MUST HAVE A VALID, UNRESTRICTED INSURABLE DRIVER'S LICENSE****RESUMES AND REFERENCES ARE REQUIRED**ESSENTIAL DUTIES, FUNCTIONS AND RESPONSIBILITIES
- Maintains accounts by reviewing documents to verify accounting data as necessary,
entering data into the system. Reconciles accounts comparing account balances withrelated data to assure agreement; reviewing records and source documents to identify thesources of discrepancies; and determining the entries required to bring the account tobalance. Prepare reports reflecting the examinations made, discrepancies noted, and thecorrective entries required adjusting accounts.
- Examines accounts or resolve difficult reconciliation requiring an analysis of adjustments
and corrective entries in the patient account system. Trace transactions entered andprepare and/or provide supporting documents reflecting the source of discrepancies,corrective action required to bring accounts into agreement, prove the accuracy ofadjusted accounts, and recommend actions to prevent recurrence of similar discrepancies.
- Performs work consisting of examination for accuracy of claims and other request for
payment for (1) services provided (2) reimbursement of expenditures made bybeneficiaries and non-beneficiaries for such purposes as medical care and treatment.
- Maintains the automated accounts receivable ledger associated with third party payer
claims. Responsible for associated records and documentation. Reviews and reconcilesall third-party payer documents for correct data, on all third-party vouchers for accurateclaim numbers.
- Ensures that all payments received are batched and posted to the Accounts Receivable
(AR) within 72 business hours of receiving all supporting documentation.
- Prepares all pertinent documents for refunds to payers; this process involves direct
communication with payers and other associated entities. Prepares monthly, quarterly andannual reconciliation and recapitulation of third-party billing to assure that collection,billed data, and the computerized and manual reports are in balance.
- Prepares all daily, weekly and monthly reports for review and approval. Provides
solutions for issues and completed documentation for any discrepancies.
- Receives and reviews all Explanation of Benefits (EOB) and Remittance Advice (RA)
from third party payer. Identifies and records proper claims numbers on each remittanceand post to the appropriate account.
- Posts all contractual adjustments related to and in conjunction with posting of payments
in accordance with hospital policy and procedures. Monitor accounts balances, reviewposting to ensure accuracy and recommend appropriate corrective action.
- Audits all documents received for completeness and accuracy; analyze and select guide to
determine whether payments are full or partial in accordance with hospital policy andprocedures; whether they are timely; and whether remittance are advances, installments,or supplements.
- Processes secondary and tertiary billing after posting payment of initial claims.
- Maintains current documentation and guidelines pertaining to reimbursement activities in
appropriate files, binders, etc., and ensures preparation and distribution of copies to allappropriate disciplines.
- Maintains EDI (Electronic Data Interchange) applications for automated posting into
Resource and Patient Management System (RPMS) Accounts Receivable. Initiates filetransfer of ANSI x 12835 file (electronic RA & EOB) from electronic database (payerportal, third party healthcare exchange, etc.) to identified shared drive. Initiates downloadof electronic files to RPMS-Accounts Receivable module. Monitors, identifies andreports any application problems.
- Safeguards the contents of the alternate resources program health insurance claims as
privileged communication which disclosure of information only within the limits ofFDIHB policy.
- Keeps abreast of total program operations, the priorities and goals of the Alternate
Resources Program; and current changes in policy regulations on eligibility; andparticipates in planning, implementation, and improvements of the FDIHB accountsreceivable program.
- Resolves problems in balances of patient accounts - payment and adjustment
discrepancies. Develops control records, verifying the accuracy of budgetary dataadjusting dollar amounts on accounts by line item and preparing reports reflecting thediscrepancies.
- Verifies the accuracy of payment history for the period involved, determines the extent of
underpayment or overpayment, if any.
- Resolves unidentified cash received by the hospital according to hospital policy and
procedures; and completes special projects within required time frame to ensurecompatibility of project specifications.
- Performs other duties as assigned.
MANDATORY MINIMUM QUALIFICATIONS:Experience:Two (2) years' experience in a healthcare setting in any of the following areas:Patient RegistrationCodingBillingCollectionsEducation:High School or Equivalency (HSE)Please email degree or transcripts to ...@fdihb.orgNAVAJO/INDIAN PREFERENCE:FDIHB and its facilities are located within the Navajo Nation and, in accordance with Navajo Nation law, has implemented a Navajo/Indian Preference in Employment Policy. Pursuant to this Policy, applicants who meet the minimum qualifications for this position and who are enrolled members of the Navajo Nation will be given primary preference in hiring and employment for this position and members of other federally recognized Indian tribes will be given secondary preference. Other candidates will be considered only after all candidates entitled to primary or secondary preference have been fully considered.