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CONFEDERATED SALISH AND KOOTENAI TRIBES
OF THE FLATHEAD NATION
PO BOX 278
PABLO MT 59855
PERSONNEL OFFICE FAX: (406) 675-2711
WEBSITE ADDRESS: cskt.org
**RE-ADVERTISED DUE TO LACK OF APPLICANTS**
TITLE: Paid HealthCare Patient Account Representative
LOCATION: Tribal Health Department
SALARY: $14.06 to $16.33
CLOSING DATE: Thursday, May 11, 2017 at 5:30 p.m.
Position is not a Testing Designated Position within the definition of the CSKT Drug Free Workplace Policy effective January 1, 1998. The successful applicant, if not already employed by the Tribes must pass a pre-hire drug test and serve a mandatory six (6) month probationary period.
The Paid Healthcare patient account representative/s is an experienced employee who generates medical claims authorizations for approved services after examining patient registration eligibility and alternate healthcare resources eligibility. The available Paid Healthcare budget is limited and as a result, the employee’s purpose is to ensure compliance with established budgets, policies and practices. The employee has an assigned processing range (alphabet and or vendors) and may pick up other reporting and processing duties as needed during the year.
Priority areas for employee/s are (1) improved referrals for alternate healthcare resource coverage; (2) timely claims and referral processing (obligation, notices to vendors and patients, payment); (3) Interface with patient registration and alternate healthcare resources eligibility determinations; ensuring that all beneficiaries are properly registered and signed up for alternate healthcare resources; (4) pended and aged medical claims resolution including communication with patient registration and with the patient; (5)pending and aged claims financial reporting to the Business Office Executive Director and Division Manager on a bi-weekly basis; (6) yearend review including cancellation of authorizations previously issued and preparation of all yearend reports (paid claims, pending claims, prior year claims authorized, deferred services requested and referred and deferred services requested and not referred) as the Business Office Manager may need and or may request.
The goal is to ensure that program regulations (federal, State, and Tribal) are followed and implemented at the local level including eligibility review, alternate healthcare resources review, payment of contract provider rates, and timely processing of all payment authorizations and denials.
Year 1 is determined to be a transition period which will require the employee to identify challenges and problems as well as offering written program solutions. Employee will be asked to interface with a new Medical Advisor, a new Medicaid on staff program, and a changed role with THD patient registration and alternate resources staff.
At the time of processor transition (June-October 2016), the processors will be aware of what are prior year claims that the CSKT THD Department has no responsibility over. All claims payments must include a date review for a determination of who is responsible to pay (Indian Health Service or Tribal Health).
The position is a combination of patient advocate and referral point, and high volume computer data entry work issuing medical authorizations. The work is technical work which involves technical knowledge of medical codes, and procedures. The goals are increased alternate resources coverage, timely eligibility determinations and accurate authorized fund balances for routine care, emergency call-ins and follow up care referrals.
Employee must also have knowledge of local medical vendors, providers, specialty care, networks, and who to contact for authorizing medical care after eligibility has been determined using the THD patient registration process. The processor can find themselves between the patient, medical provider and the patient registration staff. All efforts are in support of the patient.
MINIMUM QUALIFICATIONS (AS REFLECTED ON THE TRIBAL EMPLOYMENT APPLICATION):
· Some College coursework in Health Services, Public Health, Business Administration, Human Resources, or other relevant field preferred;
· Training and or on the job experience related to medical coding and medical procedures preferred;
· Experience in implementing CHS/ program policies and procedures,
· Demonstrated successful experience in reading, interpreting program guidance, contracts, and regulations and implementing those regulations at the local level;
· Five years experience with the RPMS computer system, FI computer system, fax machine, scanning,
· Ability to successfully pass civil and criminal background check for persons working with children and vulnerable adults;
· Ability to communicate with vendors and patients in a compassionate understanding manner.
· Professional communication skills;
· Valid and current State of Montana driver’s license;
DESIRABLE QUALIFICATIONS (AS DETERMINED BY THE INTERVIEW):
FAILURE TO SUBMIT ALL OF THE ABOVE INFORMATION WILL RESULT IN IMMEDIATE DISQUALIFICATION DURING THE SCREENING PROCESS
SUBMIT ALL OF THE ABOVE TO: Evelyn Charlo, Personnel Office, PO Box 278, Pablo MT 59855, Telephone (406) 675-2700 Ext. #1029.
FOR MORE INFORMATION: Shonda Bolen, Tribal Health Department – (406) 675-2700 Ext. #5032