ORGANIZATIONAL UNIT: Health Services Department: Purchased Referred Care (PRC)
SUPERVISOR: PRC Coordinator
FLSA: Non- Exempt
SALARY RANGE: $18.50- $27.50
ALL FULL TIME POSITIONS: In addition to your pay, your salary also includes Medical, Dental and Vision Insurance. The Biweekly deduction from employee paycheck is $40.00 for Employee Only, $95.00 Employee plus Children, $120.00 Employee plus Spouse, and $140.00 Employee plus family.
JOB SUMMARY: The PRC Patient Account Clerk is responsible for the daily processing of accounts payable and receivable. Accounts payable and receivable functions will include, but are not limited to, distributing invoices, verifying legitimacy of the billing by matching incoming claims with approved purchase orders, posting receivable payments, counseling providers and/or patients regarding approved/denied services, and acting as a liaison between the patient, their insurance company, and their providers.
CPN Health Services personnel may be assigned to provide services to patients of all ages including but not limited to Indian Children and will require a criminal history background screening.
ESSENTIAL FUNCTIONS:
- Provide guidance to patients regarding PRC policies and procedures.
- Assists with determination of eligibility and verifies and/or researches a patients’ eligibility for CHS.
- Assist with determining eligibility of new vendors and compile new vendor paperwork.
- Review incoming claims for appropriate required documentation and approval prior to initiating payment.
- Compile data and confirms accuracy upon entry of payment posting
- Process payments in accordance with contractual terms.
- Stay up to date on local, state, and federal law changes in the insurance field.
- Provides update to vendors regarding claim status requests and processing times.
- Maintain a good standing relationship with outside providers and vendors.
- Verifies patients’ insurance, eligibility, and coverage type (HMO, PPO, etc.).
- Coordinates with alternate resources for maximum benefits on behalf of the patient.
- Have knowledge of approved vendors and policies to avoid paying unauthorized invoices and expenses.
- Allocates funds/generates purchase orders within the RPMS system.
- Request EOBs from facilities when a claim with primary insurance is received without the EOB.
- Negotiate settlement of historical charges with non-contracting physicians providing ancillary care.
- Assists with recording requests made by patients and/or providers for payment of emergency medical care, resulting in an emergency room visit or admission.
- Resolve claims in a timely manner.
- Analyze and investigate complicated insurance claims.
- Calculate cost of services for multiple facility and physician claim forms.
- Prepare documentation of prior invoice and check requests on a weekly basis.
- Purchase Order Acquisitions.
- Responsible for collecting accurate documentation and entry in CPN purchasing system (RPMS System).
- Processes all ASAP patient billing statements as priority and notate in appropriate patient file.
- Review and record invoices from vendors to ensure accuracy in billing.
- Ensure payments are processed compliant with contractual term.
ADDITIONAL DUTIES:
- Perform other duties and projects as required by management.
KNOWLEDGE, SKILLS AND ABILITIES:
- Ability to communicate well with the public and the patients.
- Ability to make independent decisions, always staying objective.
- Ability to work closely with providers and PRC staff.
- Proficient in typing.
- Ability to use standard office equipment.
- Must be self-motivated.
- Must be detail oriented and organized.
- Knowledge and experience with filing systems.
- Knowledge of Microsoft Word, Excel, and ten-key.
- Knowledge or experience with basic accounting procedures.
- Ability to follow HIPAA guidelines.
MINIMUM QUALIFICATIONS FOR CONSIDERATION:
- High school diploma or equivalent is required.
- Experience in a medical setting and with Indian Health Services is preferred.
- Accounts payable and/or accounts receivable experience required.
PHYSICAL REQUIREMENTS:
- Ability to be seated or standing for prolonged periods of time.
- Some stooping, kneeling, and reaching are required.
- The ability to do repetitive works at a computer.
- A minimal ability to lift twenty (20) pounds is required.
ENVIRONMENTAL CONDITIONS:
- Health facility office environment.
Note: The above statements are intended to describe the general nature and level of work performed by an employee in this position. These statements are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of employees in this position.
