COOK INLET TRIBAL COUNCIL, INC.
Senior Director of Finance
This position is responsible for managing the day-to-day billing operations, including but not limited to timely and accurate billing activities, interactions with third party payers and participants, maintaining accurate records, as well as improvement, implementation, and administration of the billing policies and procedures. This position requires a strong focus on Medicaid billing and an understanding of tribal health systems such as the Indian Health Service (IHS).
Duties and Responsibilities:
- Ensure that all participants are screened for and enrolled in any form of reimbursement for services including, but not limited to: Indian Health Services (IHS), private insurance, Medicaid, Medicare, and self-pay.
- Submit bills and claims for reimbursement from third party payers.
- Submit invoices to participants for self-pay, unpaid co-pay and insurance deductible amounts.
- Maintain accurate and updated accounts receivable and distribute an Aging Report monthly and/or as required.
- Obtain necessary participant document such as proof of IHS eligibility, income verification for sliding scale fee and other eligibility documentation as required.
- Assist participants with application for Medicaid, Food Stamps, Permanent Fund, and any other applicable payment sources.
- Obtain all appropriate consents and releases of information required to release client information for billing purposes.
- Review all scheduled visits across the organization and assign the correct coverage and preliminary filing order at the time of the visit. Re-verify the filing order at the conclusion of the visit before claim submission. Identify, verify, and document eligibility for the correct primary payor. Obtain referrals and pre-authorizations as required for procedures. Identify participant co-payments for point of sale collections.
- Maintain knowledge of current regulations and policies of the Federal, State and private payers. Stay current on changing regulatory and billing guidelines. Stays abreast of latest developments and trends in the field of Patient Financial Services by attending seminars/workshops. Assists in the maintenance of organization policies, procedures, forms and manuals.
- Monitor payor claim acceptance and response timeliness. When necessary call, email, use payor portals to status claims. Correct and re-bill denied claims. Responsible for reviewing participant account records and third party payer issues. Escalate themes for potentially payor relations bulk resolution. Be familiar with standard concepts, practices, and procedures in healthcare.
- Ensure proper charge capture, billing and adjudication of claims in accordance with federal, state and private billing guidelines. Identify, analyze, and reconcile billing errors or omissions. Monitors unbilled accounts to determine necessary actions required to minimize the volume and value of accounts being held. Review and approve payer refund request. Responsible for analyzing and escalating themes for payer relation bulk resolution
- Maintain records and files in accordance to applicable regulations and guidance. Responsible for maintenance of general files of directives, instructions, regulations, notices, and correspondence. Ensure there is documentation of all action(s) taken for adequate audit trails. Provide documentation when requested for an audit.
- Identify and implement improved billing and collections processes, procedures, and guidelines to ensure the billing department is working efficiently and maximizing reimbursement.
- Responsible for coordination of external review of billing on an annual basis.
- Provide reports and analysis on billing activities as requested.
- Provide accounting coding for billing activity
- Responsible for reconciliation of the billing software activity to the accounting system.
- Provide support and training as necessary to provider staff to ensure understanding of billable activities and requirements.
- Participate in the Recovery Services Quality Assurance meetings.
- Obtain and process all in-coming payments.
- Assess the financial situation of each participant to establish a payment plan and work with staff/participants to ensure financial cost agreements are completed.
- Maintain confidentiality according to regulations, policies, and procedures.
- Perform all other related duties as assigned.
- Excellent organizational and time management skills.
- Demonstrated ability to work in a team environment.
- High aptitude to learn new concepts and adapt to changing regulatory/payor billing and follow-up rules.
- Highly motivated, self-starter.
- Excellent verbal and written communication skills.
- Strong problem solving and decision making skills.
- Demonstrated ability to prioritize workload to meet deadlines and fulfill all responsibilities related to this position.
- Strong knowledge of substance abuse treatment theory and programs.
- Strong computer literacy with experience in providing program support.
- Excellent attention to accuracy, details, and fact reporting.
- High school diploma or GED.
- Billing certification from an accredited Medical Billing Program or Bachelor’s degree in Healthcare Management.
- Experience in a clinical setting, tribal health system experience preferred.
- Minimum of two (2) years of experience in billing management/supervision.
- Proficiency in medical terminology and CPT coding as well as billing/collection practices.
- Proficiency in filing claims to Medicaid.
- Expertise in reading and interpreting EOBs.
- Computer experience to include billing software.
Hiring preference shall be given to eligible and qualified Alaska Native/American Indian applicants pursuant to P.L. 93-638 Indian Self Determination Act.
The information provided in this description has been designed to indicate the general nature and level of work performed by incumbents within this job. It is not designed to be interpreted as a comprehensive inventory of all duties, responsibilities, qualifications and working conditions required of employees assigned to this job. Management has sole discretion to add or modify duties of the job and to designate other functions as essential at any time. This job description is not an employment agreement or contract.