Job Summary

Incumbent is responsible for accurate and timely preparation submission of third-party carriers and intermediaries while interacting with other departments and outside agencies. Perform other related duties as assigned.

 

Job Duties & Responsibilities

• Identifies, collects, and tracks pertinent information on those patients with third-party coverage.


• Examines patient bills for accuracy and requests any missing information.


• Completes in correct format and submits appropriate document billing form using pre-determined rates for those patients with alternate resource coverage to appropriate third-party insurance carries.


• Prepares and submits insurance claims to all third-party payers for all patients who receive care at the KIC Tribal Health Clinic (KICTHC).


• Assures follow-up on all outstanding reimbursable insurance bills with insurance companies to assure maximum collection on each bill from third-party health plan carriers.


• Serves as liaison between the KIC Clinics, patient and other healthcare providers in the collections of alternate resource information.


• Posts the accounts receivables and explanation of benefits into the billing package received from all insurance carriers.


• Cross trains other incumbents in the department to related functions of this position in order for them to provide backup coverage. Receives cross training in other department positions, related duties, providing backup coverage during absence of other positions and to provide breaks daily.   


• Other related duties as assigned

 

KIC Core Competencies

Cultural Competency: To be respectful and responsive to the health beliefs, practices, and cultural and linguistic needs of KIC Tribal Members. Developing cultural competence is an evolving, dynamic process that takes time and occurs along a continuum.

Uphold Values: To make decisions and behave in a manner consistent with KIC Workplace Values of Trust, Teamwork, Respect, and Accountability, as well as Southeast Traditional Tribal Values “Our Way of Life”.

Commitment: To serve Tribal Members and set a high standard for yourself in your performance; strive for results and success; convey a sense of urgency and bring issues to closure; and stay persistent despite obstacles and opposition. 

Customer Service: Meet/exceed the expectations and requirements of internal and external customers; identify, understand, and monitor the needs of both internal and external customers; always talk and act with customers in mind; and recognize working colleagues as customers.

Effective Communication: Ensure important information is passed to those who need to know; convey necessary information with respect, clearly and effectively orally or in writing

Responsiveness and Accountability: Demonstrate a high level of conscientiousness; hold oneself personally responsible for one's own work; and do the required fair share of work.

 

 

Necessary Knowledge, Skills, and Abilities

• Knowledge of medical terminology, ICD-10CM Coding CPT,  CDT and HCPC’s Code Set.


• Knowledge of Indian Health Service medical billing and benefits.


• Knowledge of Pharmacy, Behavioral Health, Dental, Lab, and Medical Claims.


• Strong understanding and sensitivity to American Indian/Alaska Native (AI/AN) Tribal culture and lifestyle, working effectively with AI/AN populations.


• Effective oral and written communication skills with sensitivity to the lifestyles of targeted participants.

• Skills in operating personal computers using a variety of computer software.


• Ability to establish and maintain cooperative working relationships with management, coworkers, and outside contacts.


• Ability to maintain strict confidentiality and comply with all applicable federal and tribal privacy laws and KIC policy (HIPAA, HITECH, ect.)


• Ability to learn and apply program/agency operating policies and procedures.


• Ability to manage multiple priorities and tasks concurrently and meet deadlines.


• Ability to work independently as well as with teams.

Working Conditions

• 
  

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

  
  
  

  While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms; and talk or hear.  The employee is frequently required to stand and/or sit. The employee is occasionally required to walk, sit, climb, or balance. The employee must frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, peripheral vision, and depth perception.  The noise level in the work environment is usually average.

  
  
  

  Position works a large portion of time in front of a computer screen, researching and reviewing various documents for final disposition to internal/external customers. ​​​​​​​

  
  
  

  The environment involves the usual risks and stress of an office environment with a public service facility. The employee may be exposed to communicable diseases. Safety precautions for employees such as blood drawing for screening of various diseases such as hepatitis, required immunizations, etc. are necessary. The employee is occasionally subject to verbal abuse, threats, and physical violence from angry, hostile, or disgruntled patients and/or family members.

  
  
  

   

  
  
  

  Conditions of Hire

  
  


• May be required to possess and maintain a valid driver's license or capable of obtaining one, as well as be insurable by KIC’s company insurance.


• KIC is a Drug-Free Workplace. All employees must adhere to KIC drug and alcohol policies and procedures to ensure a safe workplace. Employees must pass a pre-employment and subsequent random and/or for cause drug and alcohol screening to be eligible for and maintain employment.


• KIC has several positions that must comply with the P.L. 101-630 Indian Child Protection and Family Violence Protection Act (ICPA); all employment offers in the "covered" classification are conditional until KIC has received a Federal criminal background check verifying eligibility to work in these programs.