Oversees day-to day operations of the PRC Business Office for Health Services; Supervises PRC Billing Specialist, AIHP Billing Specialist, Business Office Assistant, Pathways Case Manager, and Alternate Resource Specialist; develops and enforces policies and procedures and ensures accuracy and efficiency in PRC billing processes.
Duties & Responsibilities:
Oversees PRC Business Office Operations for Health Services including the supervision and development of staff.
Develops and enforces policies and procedures that ensure the utmost accuracy and efficiency.
Oversees the processing of all Purchased and Referred Care, NY State and Federal Government funded patient/client eligible benefit program and reviews related payments.
Coordinates with Patient Access department to ensure accurate insurance verification/documentation of all Health Services patients/clients is obtained and maintained.
Reviews, coordinates and implements competency guidelines and auditing processes with Admission and Information Technology departments for Health Services staff.
Oversees all Pathways services and programs including, but not limited to assistance with applications to County Departments of Social Services (DSS), Social Security Disability Insurance (SSDI), Family Court, Community Action Agencies, Liberty Resources, County SPOA, etc.
Oversees Pathways assistance with crisis situation including providing transportation to shelters, food banks, rehabilitation programs, or to other sites to obtain emergency support.
Reviews income eligibility and approves all Pathways Program related assistance provided to clients.
Oversees all Pathways Committees. (School supplies, Help for the Holidays Committee).
Oversees all USET related activities, attends Health Director Committee Meetings and monthly Health Director Committee Conference Calls, reporting back all pertinent information to Clinical Director and Health Operations Director.
Oversees Utilization Review and Patient Satisfaction Survey Committees.
Demonstrates continuous effort to improve operations, decrease turnaround times, streamline work processes, and work cooperatively and jointly to provide quality seamless customer service.
Assists with processing employee travel as needed.
Tracks and monitors all Health Services time off in Kronos and Outlook and provides regular updates on staff to department managers.
Processes all Health Services Staff payroll through Kronos weekly.
Adheres to Oneida Indian Nation Health Services Security and Confidentiality policies and procedures in regards to all daily job functions and receives annual update training regarding each area.
Performs other duties as assigned.
Associates degree in a business or health-related field of study, Bachelors degree preferred; an equivalent combination of education and experience will be considered.
Two to five years of related experience in the medical billing/coding field.
Knowledge and experience with Medicare/Medicaid rules and regulations
Knowledge and experience with health insurance claim form requirements for medical billing purposes.
Knowledge and experience with commercial insurance claim rules and regulations.
Knowledge of HIPAA requirements and record retention compliance.
Knowledge of electronic claim submissions and remittance procedures.
Strong written and oral communications skills.
Certified in Medical Coding preferred.