Navajo Preference Employment Act : In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference. Overview:
POSITION SUMMARY
The purpose of the position is to plan, organize and monitor accounts receivable management to ensure maximized institutional, professional, pharmacy, and dental revenue through effective collection and cash posting processes. Incumbent is responsible for management, providing technical direction, understands process management and exhibits team motivation. Maximizes reimbursement and assures that Cash Goals from Patient Revenue for TCRHCC is understood and achieved. Understands, monitors, and participates in the leadership and achievement of Patient Financial Key Performance Indicators. Responsibilities will also include delegation and assistance to the Director of Revenue Cycle. The position provides leadership for Accounts Receivable operations while overseeing revenue integrity, billing compliance, coding validation, audit activities, denial prevention, reimbursement integrity, and revenue cycle performance improvement initiatives. The incumbent collaborates with Patient Financial Services, HIM, Coding, CDI, Compliance, and Clinical departments to identify reimbursement opportunities, reduce denials, strengthen internal controls, ensure regulatory compliance, and improve cash collections and revenue cycle outcomes.
Qualifications:
NECESSARY QUALIFICATIONS
Education:
Associate’s Degree in Business Administration or related business field (Finance, Accounting, Administration, etc.) or an equivalent to 18 months of experience
Experience:
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Minimum three-years of successful supervisory or management experience.
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Minimum five-year experience as a medical coding, medical billing or accounts receivable technician in a tribal or non-profit healthcare patient accounting setting.
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Experience conducting revenue cycle, billing compliance, coding compliance, and reimbursement audits.
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Experience analyzing denials, underpayments, payment variances, and reimbursement trends.
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Knowledge of CMS, OIG, Medicare, Medicaid, and commercial payer billing regulations.
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Experience developing corrective action plans, audit monitoring programs, and staff education initiatives.
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Demonstrated knowledge of ICD-9 and ICD-10, and CPT/HCPCS coding/billing procedures, Uniform Hospital Discharge Data definitions regarding diagnostic and procedural sequencing in order to interpret and resolve problems based on information derived from system monitoring reports and the UB-04, HCFA-1500, and ADA billing forms submitted to the third-party payer
License/Certification
Obtain a Certification as a Revenue Cycle Representative through the Healthcare Financial Management Association (HFMA) one year from date of hire
Other Skills and Abilities:
A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas:
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Positive working relationships with others
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Possession of high ethical standards and no history of complaints
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Reliable and dependable; reports to work as scheduled without excessive absences and no reported attendance issues
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ability to access and use multiple data systems.
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Ability to plan and lead effective team meetings and training
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Possess expertise in professional communication, interpersonal, organizational leadership and team building skills
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Possess excellent customer services skills for internal and external customers
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Ability to work under pressure and making quality and effective decisions
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Ability to positively motivate individuals and teams to meet or exceed department expectations/goals.
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Completion of and, above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job
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Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the job
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Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job
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Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading, or incomplete information, as determined by TCRHCC.
MENTAL AND PHYSICAL EFFORT
The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Physical:
The work is primarily sedentary with the following physical requirements; Prolonged (3/4 of workday) sit, stand, walk, reach and maintain balance. Other prolonged physical requirements are the ability to use simple grasping with both hands and keyboard use. Vision requirements include the ability to see up close, color vision, depth perception, and seeing fine details. Hearing requirements include the ability to hear normal speech, telephone use and overhead pages. The incumbent will also frequently (1/2 the workday) have the physical ability to lift up to 25 pounds, push/pull up to 10 pounds and bend, kneel, crouch, twist. They will also frequently be required to use fine hand manipulation and firm grasping. On occasion (1/4 of the workday) the incumbent may be required to drive, climb, lift up to 100 pounds and/or push/pull up to 100 pounds.
Mental:
Exercise a high degree of judgment and leadership in planning, organizing, staffing, directing, evaluating and business office activities. ¾ of the workday incumbent must have the ability to handle a high degree of flexibility and handle multiple priorities in stressful situations. Incumbent will also frequently have the ability to cope with high stress levels, make decisions under high pressure, demonstrate a high degree of patience while working in areas that are close and crowded. Incumbent may also be required to on occasion cope with anger/fear/hostility of others and manage altercations in a calm manner.
Environmental:
Incumbent may be exposed frequently to infectious diseases and chemical agents. On occasion may be exposed to dust, fumes, gases, unprotected heights, loud noises, hazardous or moving equipment and extremes in temperature or humidity.
Responsibilities:
ESSENTIAL FUNCTIONS:
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Manages and leads the accounts receivable and cash posting functions and staff in the area of medical (Institutional & Professional), Pharmacy and Dental, follow-up, claims’ appeals, denied claims resolution, cash posting, and contractual adjustments.
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Supervisory experience of 10 or more employees.
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Lead revenue integrity and billing compliance reviews to identify reimbursement opportunities, coding accuracy issues, billing vulnerabilities, and regulatory risks.
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Conduct and oversee audits involving claims submission, coding accuracy, medical necessity, documentation support, payer compliance, charge capture, and reimbursement integrity.
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Perform trend analysis of denials, underpayments, payment variances, and aged AR to identify root causes and implement corrective actions.
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Partner with HIM, Coding, CDI, Compliance, and Clinical Operations to improve documentation quality, coding accuracy, and reimbursement performance.
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Develop audit work plans, monitoring tools, and internal controls designed to improve revenue cycle compliance and reduce financial risk.
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Prepare executive-level reports summarizing audit findings, denial trends, compliance risks, recovery opportunities, and operational recommendations.
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Provide education and training regarding payer requirements, coding compliance, documentation standards, and reimbursement regulations.
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Support appeals, denial prevention initiatives, DRG validation reviews, coding-related reimbursement issues, and payer audit responses.
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Utilize data analytics and reporting tools to identify revenue leakage and improve reimbursement outcomes.
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Supervisory experience of 10 or more employees.
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Medical collections with mathematical skills required to calculate practical application of accounts receivables and contract reimbursement.
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Thorough knowledge of third party payer rules and regulations (i.e. Medicare, Medicaid, Managed Care, Commercial Insurance, Workers’ Compensation, Motor Vehicle Insurance)
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Experienced with charge master, EDI claims, medical billing, E.H.R., CCI Edits and Claims Scrubbing, and Insurance Verification of Benefits systems.
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Develops, implements and maintains accounts receivable and cash posting policies and procedures.
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Establishes and maintains a working relationship with Medicare and Medicaid intermediaries, state and federal agencies, area employers and private insurance companies.
- Proficient with MS Excel and Word software applications.
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Develops statistical reports and control methods, which identify staff productivity standards and results. Identifies limitations and provides information for staff performance.
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Provides technical assistance to management, medical providers, patients and other facility personnel by obtaining information relative to collection of payments and cash posting requirements.
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Coordinates and oversees work of staff; has the responsibility of distributing workloads as necessary.
- Responsible for maintaining time and attendance in timekeeping system of staff.
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Monitors productivity of staff to ensure it meets production standards. Assures staff is provided a work environment conducive to productivity and good health.
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Trains employees and holds periodic (in-house) training sessions. Assists in interpreting regulations, requirements and procedures; provides technical assistance to resolve patient accounting system issues.
- Reviews staff work for conformance to policies, procedures, and practices relating to Alternate Resources regulations, review of appropriate E&M, correct CPT/HCPCS codes, American Medical Association (AMA) requirements, American Dental Association (CDT-2), and the Health Care Finance Administration (HCFA) guidelines.
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Prepares and conducts employee job performance evaluations and forwards to Director of Revenue Cycle for concurrence.
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Responsible for the orientation and education of staff to ensure compliance with new and existing regulations of third party payers (i.e. covered services, limitations, etc.).
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Assists with testing of new software, implementation of new payer requirements and guidelines, CMS regulatory guidelines, new process flows, etc.
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Evaluates and addresses issues and concerns relatives to daily operations of assigned areas, also provides recommendation/suggestion to improve the overall operations (i.e. cost containment via personnel management) to the Director of Revenue Cycle
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Responsible to initiate, carry out, and enforce disciplinary action policy and procedure with staff when needed.
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Verifies accuracy of services and billed amounts, and that services are allowed by appropriate regulations, directives and payer guidelines.
- Identifies errors, omissions, duplications in documents and contacts the appropriate individuals to resolve problem.
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Responsible for providing monthly reports, organizing schedules (i.e. regular, overtime, etc.).
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Attends and participates in management meetings as requested.
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Accepts delegation in the absence of immediate supervisor.
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Ensure proper PPE is worn at all times while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, if available), and eye or face shield.
- Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (see CDC website for most current updates)
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Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a high level of patient, visitor, employee, and external customer satisfaction.
- Performs other duties and special projects as assigned or required.
