Position: Biller/Collections Specialist (Reg-Full-Time)

Program:  Wind River Family and Community Health Care

Salary:  $19.00 Per Hour

Opening Date:  January 9, 2020

Closing Date:  January 24, 2020

Hours: Monday-Friday 8:00am-4:45pm

Summary:  

Wind River Family & Community Health Care provides ambulatory health care for the service population of the Wind River Reservation. The Payment Poster/Collector serves as a member of the administrative staff of the ambulatory health care clinic located in Arapahoe, Wyoming.

The incumbent is responsible for accurate and timely processing and posting of all incoming payments and denials of payment from insurance companies, patients and third-party payers.    The incumbent in this position will research account information, post payments, make adjustments as necessary and ensure proper filing and submission of denied and supplemental claims to third party carriers and Intermediaries while interacting with other departments and outside agencies. 

Job Duties:

  1. Process and manage the filing of denied medical billing claims for a variety of health related services (i.e., Medical, Dental, Behavioral Health, Chemical Dependency, Optometry, Pharmacy, Radiology, etc.) 
  2. Process payments for health carriers to include, Medicare and Medicaid, private insurance carriers, railroad, self-insured agencies, government agencies, etc. 
  3. Ensure timely posting of payments and submission of denied claims to all health carriers to include Medicare, Medicaid and all third-party payers to avoid any delays in the collection of payments.   
  4. Process denied medical claims daily listed on Remittance Advises from health carriers by utilizing carrier claim forms or electronic claim filing sources; accurately and in a timely manner. 
  5. Review daily Remittance Advises to identify any billing and processing problems.  
  6. Ensures insurance payments are in alignment with fee schedules. 
  7. Conducts monthly audits of posted charges, payments and denials for corrective action. 
  8. Ensures comprehensive accounts receivable follow up is conducted 
  9. Identifies problem areas in denials and coding errors and prioritizes work lists/workflow. 
  10. Monitors the overall revenue cycle to ensure timely and accurate payment processing. 
  11. Understands and notes any write-off delinquent accounts ensuring third party payers are closely monitored. 
  12. Initiates and answers pertinent correspondence. Maintains required electronic and hardcopy financial records and files for audit purposes. 
  13. Shall embrace cultural differences and interact positively with internal staff as well as external contacts in a culturally competent and respectful manner. 
  14. Help with the lockbox process when necessary.
  15. Prepares lockbox payment batches for processing.
  16. Maintain knowledge of HIPAA regulations.
  17. Maintain knowledge of insurance payer/plans.
  18. Maintain knowledge of Standard ANSI Codes, adjustments, and remit denial codes. 
  19. Provide training and assistance to other staff relating to questions regarding payment posting, correcting errors and missing payments.
  20. Provide assistance on special projects assigned.
  21. Attend and participate in meetings as necessary.
  22. Process Provider information through PECOS annually
  23. Keep an updated list of providers license expiration dates to insure no interruption in the submission of claims.
  24. Update RPMS once notification is received of providers approval to bill from the Centers for Medicare & Medicaid Services.
  25. Check RPMS for pended claims per provider and process them.
  26. Update provider list and distribute to all necessary departments within WRFCHC
  27. Performs other duties as assigned.

Knowledge Required:

  • Knowledge of reading and explanation of medical benefits (EOB)) and of CPT codes.
  • Knowledge of electronic payment remittances (EDI) process
  • Knowledge of third-party payers, and a thorough understanding of their processes and payment practices
  • Knowledge of Standard PC and EMR (RPMS) system(s) 
  • Knowledge of Word
  • Knowledge of Excel
  • Knowledge of Business Office rules and procedures
  • Knowledge of Tribal programs
  • Knowledge of ICD-10 and CPT coding 
  • Good math skills; ability to calculate fractions, decimals and percentages
  • Good verbal and written skills
  • Good organizational skills
  • The ability and skill to compile and write reports from various documents maintained within the Business Office.
  • Must maintain strict and complete confidentiality of all administrative, medical and personnel records, and all other pertinent information that comes to his/her attention or knowledge. 
  • Must have the ability to work under stressful situations 

Minimum of (1) years of experience in payment posting and collections in a healthcare setting, which demonstrates expert knowledge of established professional medical billing processes, procedures and protocols.  Will possess a high degree of working knowledge and experience in RPMS 3P, A/R, medical service claims filings with a variety of health carriers, Medicare, Medicaid, both electronically and/or by paper.

In addition to the above-named duties, this position requires effective communication with other personnel in the administration and clinic environment.  

Personal Attributes:

The incumbent must maintain strict confidentiality and high ethical standards in performing the position.  The incumbent needs to be respectful, possess cultural awareness and sensitivity, be flexible, and demonstrate sound work ethics.

How to Apply:

Complete a Northern Arapaho Tribal application form and submit it to the Northern Arapaho Human Resources program.  Applications can also be hand delivered to Northern Arapaho Human Resources at the Tribal Complex Building, located at 533 Ethete Road, Ethete, WY., or to the WRFCHC HR Department, at 120 North 6th Street East, Riverton, WY.  Indian preference applies.

Application forms and the full job description can be obtained on the Tribe‚Äôs website at www.northernarapaho.com, or at www.windrivercares.com 

For more information please call 307-856-9281 Ext. 134

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