| Required Skills: | 1. Reports to TPBS/PRCC the information to submit the Catastrophic Health Emergency Fund (CHEF) cases, as necessary.
2. Assist to ensure that patients keep alternate resource activities by serving as a contact for PRC Program.
3. Displays a positive and professional manner in promptly respond to all requests, complaints, and problems.
4. Demonstrates courtesy, respect, and sensitivity to the needs of all others including visitors and co-workers.
5. Knowledge of the PRC Program and services including an awareness and understanding of the purpose, objectives, commitments, and priorities to perform both recurring and special assignment.
6. Knowledge of various third parties such as Medicare, Medicaid, private insurance, etc., availability of health care resources, rules of eligibility for medical and other available programs to assist in payment of health care costs.
7. Knowledge of medical terminology and medical care practice procedures.
8. Receives and examines alternate managed care resources claims to ensure claims are complete with appropriate supporting documents, which typically include utilization review certifications. Verifies accuracy of health claims and that that claimed amounts are authorized, that items of services billed are allowed by appropriate regulations, decisions, directives, and other controlling guides. Identifies errors, omissions, duplications in documentation and contacts the appropriate individuals to resolve problems.
9. Identifies inconsistencies and/or discrepancies in medical documentation by notifying the appropriate providers and/or other departments within the facility for complete charge capture and abstraction. All providers and identified risk departments will follow-up to ensure completion, in compliance with the policy and utilization review/compliance program.
10. Prepares and distributes billing demands on third-party eligible patients receiving health care services.
11. Acts as a contact person for insurance billing companies; notifies the insurance carrier within the required timeframe to ensure service and reimbursement processing; and contacts insurance companies when an error in payment or provider write-off is identified.
12. Develops, implements, and monitors billing policies and procedures for programs that provide billing activities; transmits billing for reimbursement to the State for targeted case management services; and ensures all billing sheets are submitted for billing and paperwork sent for payment posting.
13. Implements provider enrollment and updates for medical, dental, pharmacy, CD and MH, ensuring all providers are added to all systems - Advantage, EHR, Dentrix and McKesson.
14. Documents insurance information on clients.
15. Prepares reports for management to aid in the analysis of revenue generated and submits adequate and timely reports upon request and when necessary.
16. Follows data privacy guidelines and safeguards for reimbursement claims and medical records; maintains confidentiality and professional ethics at all times.
17. Updates all paperwork needed for medical and dental clinics.
18. Ensures all data entry is completed in a timely manner including data entry for medical, dental, CHR, PHN, MH, CD and referrals.
19. Contacts managed care companies for authorization when needed; tracks dates of services, paid and unpaid.
20. Works cooperatively as part of a team and promotes teamwork with co-workers.
21. Engages in on-going assessments to ensure quality of service is being provided.
22. As an employee of the Bois Forte Reservation, will follow the Bois Forte Procurement Policy and any other applicable procurement requirements when obtaining goods and/or services for the Bois Forte Band of Chippewa.
23. Performs other duties as assigned. |