Location: Kenai,AK, USA
Department: Health SystemsProgram: Health SystemsReports to: Health Systems DirectorSupervises: Revenue Cycle Technician *2Employment Status: Full-TimeFLSA Status: ExemptSchedule: ExemptPreference: TERO Ordinance 2017-01, P.L. 93-638Job SummaryThe Revenue Cycle lead will be responsible for Health Care billing and coding for the Kenaitze Indian Tribe. This position serves as the point of contact and liaison between management and the third part billing contractor. Major functions include, but are not limited to, coordinating billing and collection activities, maximizing payments, performing audits, and process improvement.Essential FunctionsCoordinates billing and collection activities between providers and third-party billing contractorMonitors accounts receivable for revenue leakage; Oversees and monitors compliance with healthcare billing coding regulations and accounts receivable revenue leakageTracks, analyzes, and reports healthcare revenue cycle performance targetsAssists billing contractor in credentialing and enrolling providers with all insuranceMonitor denials and reasons; must be able to understand payer's EOB;the activities of registration, and admission departments for errorsTracks, analyzes, and reports healthcare revenue cycle performance targetsEnsures the third-party contractor is accurately billing claims timelyMust be able to work closely with the third-party billing and coding contractors, finding issues that prohibit claims from going to the payorSetting A/R Goals for the third-party contractors; Ability to Work closely with departments director/managers to minimize errors that will prevent claims from processingEnsures compliance with Tribal, federal, state, and local employment laws and regulations, Tribal policies, and TERO ordinanceIt is the intent of this job description to highlight the essential functions of the position; however, it is not an all-inclusive list. The incumbent may be called upon and required to follow or perform other duties and tasks requested by his/her supervisor, consistent with the purpose of the position, department and/or the Kenaitze Indian Tribe's objectives.Working ConditionsLifting RequirementsSedentary work - Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are metPhysical RequirementsStand or Sit (Stationary position)Walk (Move, Traverse)Use hands/fingers to handle or feel (Operate, Activate, Use, Prepare, Inspect, Place, Detect, Position)Stoop, kneel, crouch or crawl (Position self (to), Move)Talk/hear (Communicate, Detect, Converse with, Discern, Convey, Express oneself, Exchange information)See (Detect, Determine, Perceive, Identify, Recognize, Judge, Observe, Inspect, Estimate, Assess)Repetitive MotionOSHA CategoriesCategory III - Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aidEquipment and ToolsList Equipment used for job: Computer, scanner, fax, copier and other office equipmentDrives KIT or Personal Vehicle: PersonalTravelLocalQualificationsEducationBachelor's degree in finance/accounting, health care management, business administration or related field, or a combination of education and experience in a related field may be substituted for a degree5 years of Health Care experience preferred. Patient access, Billing and CodingExtensive knowledge between Admitting, Clinical Areas, Coding and Financial AreasExperienceFive (5) years' experience in management of the healthcare revenue cycleExperience in accounting for healthcare revenue recognition and financial statementsExperience working with Medicare, Medicai, and other payorsMust be able to understand Alaska Medicaid, billing guidelinesKnowledge of computer systems in Cerner, MyEvolv and DentrixMust be able understand denials and reasons, and payer's EOBStrong understanding of Revenue Cycle Management and Regulatory AgenciesExperience in Federal and State regulatory associated to billing/collectionsShould have exceptional knowledge in Patient Access/Scheduling, and authorizationsMust be able receive and express detailed information through oral and written communicationsExcellent interpersonal and organizational skillsPreferredMHA, CPA, or equivalent advanced degreeE.H.R. system administration role with CERNER, Dentrix, or MyEvolvHealthcare Financial Management CertificationAdvanced skills with Microsoft applications including Word, Excel, and OutlookKnowledge and experience working with cultural diversitiesLicense/CertificationMust have a valid Alaska State driver's license and must remain insurable under the Tribe's policy or obtain within 90 days of hire to conduct Tribal businessSpecial SkillsKnowledge of Medicare, Alaska Medicaid, and third-party payer regulations and how to work within their guidelinesAdvanced technical, analytical, problem-solving, and project management skills demonstrated through prior professional experienceRemains current on healthcare industry practices and government rules to predict/inform revenue cycle impactThorough understanding of the healthcare revenue cycle process, including staff roles and responsibilities, work requirements, and best practicesProficiency in the use of computers, E.H.R, office productivity software, and health practice management applicationsCoverage of Billing and Collections services for all assigned accounts as needed: Level 1 and 2 claim submissions through multiple billing software platforms and clearinghouses, Level 1 and 2 AR follow-up procedures in accordance with each contract and tribe's proceduresAbility to prioritize multiple projects and deadlinesProven organizational and time management skillsProficiency with Microsoft Suite or obtain training within 90 days of hireAbility to work independently as well as collaborativelyConducts business in a service-oriented manner that is attentive, pleasant, respectful, and kind when dealing with un'ina, visitors, co-workers, and othersThis position is a Covered Position subject to all requirements of the Alaska Barrier Crimes Act (ABCA) and to the Indian Child Protection and Family Violence Prevention Act, (ICPA). ABCA and ICPA requirements apply and must be complied with at all times in order to remain in the position.*Memorandum of Understanding: Serves as documented evidence that the Kenaitze Indian Tribe has expressed the ineligibility of an employee to operate motor vehicles owned, leased or rented by the Kenaitze Indian Tribe, or to operate a personal vehicle on behalf of the Kenaitze Indian Tribe.[]{style= font-fa }