CHS Claims & Payment Manager - CHS - Okmulgee

MINIMUM QUALIFICATIONS

Education – Bachelor’s Degree in Business Administration or related field is preferred but not required.

Experience – One (1) year of experience in benefits administration, medical billing or related field.  Experience gained through working in a tribal setting is preferred.

Licenses & Certification -

Knowledge & Skills –

1. Knowledge of all aspects of Contract Health Services in a tribal PL 93-638 environment.  Knowledge of IHS and MNHS policies and procedures related to CHS.


2. Knowledge of Managed Care guidelines, Medicare/Medicaid regulations and guidelines, third party billing, utilization review, Rural Health certification process, etc. related to CHS.


3. Knowledge of the Privacy Act and other related regulations with regards to confidentiality and the release of medical information.


4. Ability to communicate and interact effectively with patients and their families, staff members, other MCNDH employees, tribal officials and the public both orally and in writing.


5. Knowledge of ICD-10-CM coding, APG coding and in the EPIC system.


6. Ability to supervise subordinate staff members and provide guidance and assistance to other staff members not directly under the incumbent’s span of control in a professional manner.


7. Knowledge and skill to utilize a PC in a Windows environment and to operate other necessary office equipment.


8. Ability to deal with unruly patients and their family members under trying circumstances.

 JOB PURPOSE

The purpose of the position is to provide supervision of claims and payments through Contract Health Services. Incumbent provides supervision to the Claims Support Specialists performance of duties. It also has responsibility in conjunction with the coordination of the staff within Muscogee (Creek) Nation Department of Health.

Provides supervision of claims accounts. Provides support to supporting staff.  This position will also interact with the public both internal and external and good communication skills are a must. 

JOB DUTIES

1. 
   

   Provides strong/broad understanding of claims analyst process.

   
   


2. 
   

   Responsible for promoting quality, superior customer service.

   
   


3. 
   

   Identifying enhancements and changes to workflow to increase effectiveness and productivity.

   
   


4. 
   

   Knowledge of third-party billing systems, general medical terminology used in the referral process and payment process.

   
   


5. 
   

   Must be able to make comprehensible decisions, multi-task and prioritize tasks and meet deadlines.

   
   


6. 
   

   Conducts training for staff.

   
   


7. 
   

   Ensures and maintains department quality and turnaround standards.

   
   


8. 
   

   Organizing and documenting workflow and processes.

   
   


9. 
   

   Analyzes and verifies patient referral information and any third-party billing resources, checking internal systems and third-party systems for eligibility e.g. Oklahoma Healthcare Website, Medicare, Private Insurance, etc.

   
   


10. 
    

    Gathers and analyzes information from internal systems that includes medical systems for electronic health records and EPIC Contract Health System.

    
    


11. 
    

    Protects organizations value by keeping information confidential and abiding by the HIPPA and Privacy act guidelines maintain strict confidentiality regarding medical information and release of that information.

    
    


12. 
    

    Ensures claim payments enter accurately, and documents support the payments by inputting data and verifying claims to maintain accuracy of payments and obtains supplementary information for preparing payments such as Explanation of Benefits (EOB), ensuring third-party and alternate resources has been applied before payment is rendered.

    
    


13. 
    

    Ensure compliance of all claims in accordance with the CHS Department and workflow.

    
    


14. 
    

    Answers accounting and financial questions by researching and interpreting data and has good oral and written communication skills for communicating with third-party vendors, hospitals, providers, and patients and their families.

    
    


15. 
    

    Updates job knowledge by participating in educational opportunities; reading professional publications; participating in professional organizations.

    
    


16. 
    

    Accomplishes accounting and organization mission by completing related results as needed.

    
    

SKILLS/QUALIFICTIONS

Basic Accounting Principles, HIPPA Privacy Act Knowledge, Reporting Skills, Deadline-Oriented, Time Management, Attention to Detail, Confidentiality, PC Proficiency (MS Office Suite of Products), Productivity, Verbal Communication, General Math Skills.