Hybrid Health Claims Auditor presso Northeastern Tribal Health System

Description

Position Summary: The individual will work directly with various members of the Healthcare team to ensure that claims received for services

approved through Purchased Referred Care are compliant with industry, federal and state guidelines.

Position responsibilities:

• Analyzes and creates purchase order delivery invoice for every approved referral.
• Process all UB/HCFA 1500 claims and primary EOB's for payment to outside vendors for approved care.
• Process coding/edit rules utilizing multiple coding tools for all claims to ensure all claims are paid correctly.
• Process billing rules edits for all claims to ensure PRC rates and sequestration rates are applied to claims.
• Create NTHS Explanation of Benefits or denial for all claims received from providers of service.
• Create payment documents for all claims to send to finance department for weekly financial processing.
• Run open purchase order reports and complete monthly report for ALL vendors to ensure there are no outstanding claims for patients.
• Communicate with billing providers to ensure that all PO’s are accounted for, paid or canceled.
• Receive and process any patient bills, contacting providers to request claims and/or EOB’s to process.
• Maintain financial spreadsheets to show amount allocated and paid per month for funding.
• Process denials according to PRC policy and regulations.
• Other duties as assigned.

Essential skills and experience:

• Prefer knowledge of basic and established procedures related to the routine and repetitive aspects of PRC support work.
• Knowledge of Medicare like rates, Novitas and CMS.
• Knowledge of ICD10 coding procedures, abbreviations, and terms used in coding healthcare claims.
• Knowledge of basic and established procedures related to electronic medical records systems.
• Must have knowledge of simple mathematical calculations. Must have knowledge of personal computers and be able to type with minimal errors.
• Basic Accounting Skills.
• Excellent interpersonal and communication skills.
• Problem analysis and problem resolution at both a strategic and functional level.

Requirements

Valued but not required skills and experience:

• Bachelors Degree in Health Administration, Business Administration or related field.
• Two years of billing experience and/or Purchase Referred Care experience.

Reporting to this position: N/A

Physical demands and work environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Physical Demands: While performing duties of job, employee is occasionally required to stand; walk; sit; reach with hands and arms; talk and hear. Employee must occasionally lift and/ or move up to 25 pounds.
• Work Environment: The noise level in the work environment is usually moderate.

Indian preference applies. Applicants should submit an application, resume with a cover letter, and a copy of CDIB or Tribal membership card (if applicable) to Northeastern Tribal Health System, Human Resources Director, Audrey Fenoughty, P.O. Box 1498 Miami, OK 74355. Selection of the qualified applicant is contingent upon drug screen and background check. Applications will be accepted until position is filled. Resumes may be faxed to Audrey Fenoughty @ (855)745-3601. Applications may be obtained from the Northeastern Tribal Health System website at https://nthsclinic.com/nths-careers.