Collections Billing Specialist - Oneida Nation

Green Bay, WI

About the Job

SALARY: $19.67/Hr. (NEGOTIABLE)
(Employees will receive 5% below the negotiated pay rate during their probationary status.)
Non-Exempt

POSITION SUMMARY

This position will perform third party billing collection for all charges for ATODA, Mental Health and other services provided to employees and community members. Continuation of this position is contingent upon funding allocations

DUTIES AND RESPONSIBILITIES:

Utilizing the electronic health records review EOB denials from insurance companies correct information is in the system. Contact patient and insurance companies to collect missing information and update information on all patient accounts. Interact with external companies and agencies as needed.
Obtain prior authorization as needed by medical assistance and commercial insurance carriers. Answer phone calls from customers and external companies regarding account information on patients according to HIPAA.
Monitor outstanding claims, denials, adjustments and provide recommendations to increase third party reimbursement.
Follow-up on all pending claims and work closely with patients and insurance carriers to ensure accuracy of insurance data.
Enter charges entered to ensure accuracy before mailing claims to appropriate carriers. Update family master file on client accounts, reconcile accounts receivable and prepare deposits. File and organize billing paperwork, documents and batches.
Interview patients eligible to ensure they understand their entitlement in an IHS contracted tribal facility. Work with patient registration in screening potential claims.
Assist in administrative aspects of collection duties to include development of billing policies and procedures in cooperation with the Oneida Health Center Billing Supervisor. Maintain Billing Policies and Procedures for effective collection of Third-Party revenues.
Provide leadership and act as an advocate to patients to assist in effectively utilizing resources such as Medicaid, Medicare, Military and Group Health/Private insurance.
Counsel patients on financial arrangements according to clinic collection policy. Process and maintain personal payment information in system, generate a receipt for transactions, to include credit card payments and payroll deductions.
Distribute program income reports as needed.
Provide and maintain necessary documents for certification of Agency and credentialing providers.
Work effectively with providers for credentialing forms and requests from 3rd party payers.
Ensure all providers are current with keeping up to date with the Council for Affordable Quality Healthcare (CAQH)
Assist management with completion of credentialing documents for providers.
Ensure Credentialing Files are current.
Provide reports to providers regarding shared responsibility for billing completion.
Refer billing invoices other than onsite billing to Behavioral Health Administration.
Run the visits of new status on a daily basis and provide feedback to providers to complete billing in real time.
Fill in as patient accounts representative as needed.
Ensure strict confidentiality of financial records.
Contributes to a team effort and accomplishes related results as required.
Adhere to all Tribal Personnel Policies and Procedures, Tribal Standard Operating Procedures, and Area and Program Strategic Plans and Policies.
The above duties and responsibilities are not an all-inclusive list but rather a general representation of the duties and responsibilities associated with this position. The duties and responsibilities will be subject to change based on organizational needs and/or deemed necessary by the supervisor.

PHYSICAL REQUIREMENTS/WORK ENVIRONMENT:

Frequently sit, walk and stand; use hands, handle, reach with hands and arms.
Occasionally lift and/or move up to twenty-five (25) pounds.
Work is generally performed in an office setting with a moderate noise level.
Work environment is not smoke free. Exposure to secondhand smoke.
A Tuberculosis (TB) Screening and/or a 2 step TB Skin Test is required within thirty (30) days of employment.

STANDARD QUALIFICATIONS:

Knowledge of Generally Accepted Accounting Principles (GAAP), including computerized accounting, bookkeeping practices, and record keeping procedures, as well as appropriate local, state, and federal regulations and requirements.
Knowledge of AAAHC, HIPAA, Workers Compensation, OSHA, Federal, State and Local regulation, DHS state licensing DHS 35 and DHS 75.
Knowledge of Mental Health and Substance abuse insurance claims procedures and documentation.
Knowledge of Mental Health and substance abuse billing procedures.
Knowledge of ICD-10 and DSM 5 diagnostic codes and medical terminology.
Knowledge of Behavioral Health standard guidelines of Medicaid and Medicare.
Skill in records maintenance.
Skill in using computerized accounting software programs, office equipment including 10-key adding machine, and word-processing and spreadsheet programs.
Skill in account balancing.
Ability to communicate effectively, both verbally and in writing.
Ability to work within Electronic Health Records to include data entry and word processing.
Ability to verify data input and correct errors; sort, check, count and verify numbers.
Ability to gather data, compiles information, and prepare reports.
Ability to use independent judgment.
Ability to interact and maintain good working relationships with individuals of varying social and cultural backgrounds, employees and officials.
Ability to analyze and solve problems and meet strict timelines.
Willingness to become a Notary Public.
Ability and willingness to obtain CPR Certification within ninety (90) days of employment.
Complete Oneida Certification on Reporting Child Abuse and Neglect training within ninety (90) days of employment.
Must adhere to strict confidentiality in all matters.
Must complete Health Insurance Portability and Accountability Act (HIPAA) training within 30 days of employment and annually thereafter.
Must be willing and able to obtain additional education and training.
Must comply with Caregiver Law and Grant conditions criminal history checks as a condition of employment to include fingerprinting.
Employees are required to have proof of immunity or dates of 2 doses of MMR and proof of immunity or dates of 2 doses of Varicella prior to starting in any position within the Oneida Comprehensive Health Division. Any refusal of vaccination(s) or failure to provide proof of immunity may disqualify the applicant.
Must pass a pre-employment drug screening. Must adhere to the Nation’s Drug and Alcohol-Free Workplace Policy during the course of employment.
Must pass a background security check with the Oneida Nation in order to meet the Employment Eligibility Requirements, Tribal/State Compact and/or Oneida Nation Gaming Ordinance as they pertain to the position. A temporary license or Gaming License issued by the Oneida Gaming Commission is required as a condition of employment and continuing employment within the Oneida Nation’s Gaming Division.
A valid driver’s license or occupational driver’s license, reliable transportation and insurance is required. Must obtain a Wisconsin driver’s license or occupational driver’s license within thirty (30) days of employment if applicant has an out-of-state driver’s license. Must be authorized as eligible to operate a Personal and Tribal vehicle under the Oneida Nation’s Vehicle Driver Certification and Fleet Management Law prior to actual start date. Must maintain driver’s eligibility as a condition of employment.

PREFERRED QUALIFICATIONS:
Applicants please clearly state on the application/resume if you meet these qualifications.

Experience working with Electronic Health Records.

MINIMUM QUALIFICATIONS:
Applicants please clearly state how you meet these qualifications on the application/resume.

Associates Degree in Health Information Technology, Medical Coding or related field; plus, three (3) years of experience in Commercial billing, Medicare, Medicaid, IHS or working in a Hospital Business office; one year working with ICD-10 and DSM 5 diagnostic codes and medical terminology.

ITEMS TO BE SUBMITTED:

Must provide a copy of diploma, license, degree or certification upon employment.
May complete a pre-employment assessment prior to hire.
Must have received or be willing to receive the COVID-19 vaccination by date of hire to be considered. Proof of vaccination required.
Background information disclosure (BID) form.

Source : Oneida Nation