Purchase Referred Care Manager- Open until filled

Confederated Tribes of Siletz Indians•Siletz, OR

8d•Onsite

About The Position

This position supervises the day-to-day activities of the Purchased/Referred Care (PRC) program aimed at providing healthcare to eligible tribal members. The Healthcare Reimbursement Supervisor oversees a team of Healthcare Reimbursement Technicians, ensuring the accurate processing of healthcare claims within the approved service area. This role requires strong leadership and analytical skills, critical thinking, and the ability to produce detailed billing and operations activity reports for the Purchased/Referred Care (PRC) department.

Requirements

Associate’s degree in healthcare administration, or related field, four years’ experience in either medical billing, or healthcare reimbursement AND 2 years of experience working within Purchase/Referred Care -OR- an equivalent combination of education and/or experience may be considered.
Two years of supervisory experience required.
Knowledge of medical terminology, diagnosis, coding and insurance terminology.
Knowledge of regulations related to Medicare, Medicaid and commercial insurance.
Knowledge of PRC rules, regulations and policies.
Proficiency in medical billing procedures and statistics for workload assessment and quality control.
Knowledge of ICD-10, CPT, HCPCS coding systems, CMS-1500 and UB-04 forms, and billing practices.
Advanced Computer skills including database, word processing, spreadsheets applications, as well as familiarity with EHR/EMR systems (preferably NextGen) and their billing procedures.
Experience in budget development and monitoring.
Experience in hiring, supervising and conducting performance reviews of team members.
Experience in day-to-day activities within a Purchase/Referred Care department.
Experience in tracking and auditing third-party and private payments.
Experience in developing and implementing policies and procedures.
Ability to communicate professionally with diverse stakeholders including clinicians, nurses, allied health staff, administrative personnel, contractors, governmental agencies, insurance payers, patients, family members, suppliers, and the public, of all age groups.
Ability to monitor activities, identify and analyze problems and propose and implement improvements.
Ability to plan, organize and supervise work activities.
Ability to promote teamwork.
Ability to demonstrate problem-solving skills.
Must possess a valid driver’s license, insurance and be eligible to drive a GSA vehicle.

Nice To Haves

Electronic and manual billing, preferred.
Become a NextGen super-user.

Responsibilities

Supervise and train Healthcare Reimbursement Technicians.
Monitor PRC program documents, provider agreements, and contracts to ensure compliance with program policies and procedures.
Approve program expenditures and authorize PRC claim payments, while overseeing accounting reconciliation of bank drafts.
Provide backup coverage for the PRC Tech II and perform all associated duties and responsibilities of this position as needed.
Prepare monthly, quarterly, and annual reports meeting accounting requirements and administrative needs, with a focus on performance metrics, financial expenditures, and recommendations for improvement.
Responds promptly and positively to requests, suggestions and needs maintaining a professional demeanor at all times.
Aid in development and implementation of enhanced workflow processes. Propose continuous improvements to enhance quality, productivity, efficiency, and cost-effectiveness of work processes.
Coordinate with internal departments and external healthcare providers and facilities to resolve escalated issues and improve workflow processes.
Coordinate with clinic patients to resolve escalated issues.
Processing Catastrophic Health Emergency Fund (CHEF) cases for reimbursement of medical expenses incurred for catastrophic illnesses and events.
Stay abreast of changes in regulations and industry best practices, implementing procedural changes as necessary.
Maintain current program guidelines and procedural manuals, ensuring staff are properly trained in handling patient accounts through individual and in-service sessions.
Ensures billing activities adhere to department protocol and compliance with Federal, PRC and third-party regulations.