Supervisory Patient Registration Specialist (Revenue Enhancement)

Tohono O'odham Nation Healthcare•Sells, AZ

About The Position

The incumbent oversees the revenue cycle management function of the TONHC Hospital and Clinics. Incumbent ensures that current third-party policies, procedures, and processes are in place for each phase of the revenue cycle. Sets goals and objectives for the Revenue Enhancement Branch (REB) that maximize third-party reimbursements. This position is located within the Tohono O'odham Nation Health Care (TONHC) Hospital and Clinics Revenue Enhancement (RE). Serve as the principal advisor to TONHC Hospital and Clinics Chief Executive Officer (CEO) and other TONHC Managers regarding third-party reimbursement programs. Incumbent responsible for planning, organizing, and initiating operations and work practices based on current third-party reimbursement and internal controls rules, regulations, and standards. The position is under the general supervision of the Deputy CEO.

Requirements

Knowledge of the Tohono O'odham culture, customs, and traditions.
Knowledge of, and ability to apply the Alternate Resources regulations; PL 94-437, Title IV of Indian Health Care Improvement Act, Indian Health Service Policy and Regulations on Alternate Resources, CFR 42- 21 (A) and 23 (F), and PL 99-272; Federal Medical Care Cost Recovery Act, the Drug Abuse Office and Treatment Act of 1972, and hospital policies and procedures governing the recovery cost of medical care provided for specific individuals.
Working knowledge of the International Classification of Diseases (ICD-10) and Current Procedural Terminology (CPT) coding.
Knowledge of reimbursable insurance procedures and requirements, including interpreting provisions of individual health and group plans.
Thorough knowledge of Medicare, Medicaid, and third-party payer regulations and how to work within their guidelines.
Attendance at special workshops and training sessions in Medicare, Medicaid, and other third-party payers assists in staying current on changing regulations.
Knowledge of HIPAA (Health Insurance Portability and Accountability Act) and ensures compliance to this act.
Knowledge of TONHC organizational structure and operating
Understanding of the overall purpose and direction and assures maximum program effectiveness to meet the needs of beneficiaries.
Principles and methods of sound management practices , including appropriate communication channels, prioritization , and participative
Excellent communication skills are for training staff on changes through continuing education.
Thorough working knowledge of the Resource Patient Management System (RPMS) and the accounts receivable management
Ability to plan, organize and cope with complex management
Ability to handle technical problems analytically and systematically , especially in times of medical or administrative emergencies.
Ability to communicate effectively, orally, and in writing to all levels of
Effective communication is needed to coordinate with various department personnel, patients, agency personnel , and outside entities requesting or requiring third -party billing information.
Expert knowledge in developing procedures, planning, organizing , and monitoring studies involving data analysis and preparing
Thorough knowledge of Public Law 94-437, Title IV of the Indian Health Care Improvement Act, P L 99-272, Federal Medical Care Cost Recovery Act, the Drug Abuse Office and Treatment Act of 1972; hospital policies and procedures governing the recovery of the cost of medical care provided to specific
Knowledge of reimbursable insurance procedures and requirements , including interpret ing provisions of individual health plans and group
Expert knowledge of regulatory, licensing, accrediting agency requirements , and medical/legal responsibilities of third -party
Expert knowledge of the interrelationships between third-party reimbursement program s and other medical care services to evaluate and modify new procedures to meet changing regulatory requirement s and health care
Knowledge of supervisory personnel management responsibilities , including recruitment and staffing, training, incentive awards, discipline, position classification, pay
Bachelors' Degree in Business or Two-Year Coding/Billing program Certificate plus three years experience in Coding/Billing .
Two years' experience supervising a revenue cycle program (Coding, Billing, Accounts Receivable).

Responsibilities

Coordinate the operations for distinct reimbursement programs (Medicare, Medicaid, Private Insurance).
Works with managers and supervisors to provide expert advice, training, and technical assistance, as required, on all patient-related revenue operations.
Is responsible for overseeing the patient account management function in general and providing instructions and guidance to the Central Business Office staff.
Ensures that documented processes and procedures are in place for receiving and posting collections, making adjustments, refunds, unallocated cash, denials, and aging.
Coordinates activity between IT, Business Office, and TON Finance to facilitate reconciliation with accounts receivable accounting system and ensure that information is submitted on a timely basis and by established cutoff dates.
Chairs the Internal Controls Committee monthly meetings and ensures TONHC Hospital and Clinics comply with established internal control standards.
Responsible for providing procedures and best practices intended to safeguard revenue for health services that are provided and for advising management on all collection activities.
Coordinates with TONHC management and supervisors to provide expert advice, training, and technical assistance, as required, on all business office operations.
Provides guidance and assistance to TONHC finance and business office staff; and is responsible for maintaining the debt management records for TONHC.
Attends local, state, and federal meetings to stay abreast of changes to third-party reimbursement rules, regulations, standards, policy, procedures, and processes.
Works with Hospital and Clinics departments to complete the annual Medicare Cost Report.
Ensures that Medicare institutional provider changes and revalidation is updated/changed timely so that Sells Hospital information is current.
Uses PECOS to update/change information and submit to CEO/Deputy CEO for approval.
Continually evaluates and reviews procedure adequacy; if necessary, modifies to meet latest technical requirements and techniques; runs month-end CEO evaluates statistical data identifying program adequacy to management.
Incumbent utilizes and implements various auditing mechanisms to ensure billing, posting, and denial management compliance.
Develops and implements a comprehensive internal quality control system within the Central Business Office (including IT).
Determine the effectiveness of such controls and their impact on the program.
Establishes and maintains a working relationship with Medicare and Medicaid intermediaries, state and federal agencies, and private insurance companies.
Ensures that cases of liability are reported to the TON Attorney's office.
Assures that medical and dental providers have timely access to information on provider networks so that referrals are consistent with payment resources.
Makes final determinations on direct care eligibility of all individuals seeking care who have not previously established eligibility and those who have been previously treated, and eligibility is now in question.
Identifies and budgets for adequate staffing levels and training in all third-party revenue functions-budgets for equipment, supplies, and services.
Directly supervises one Supervisory Health Systems Specialist (Central Business Office Manager) and one Information Technology Specialist (APPSWR) who serves as the systems manager for all Resource and Patient Management System (RPMS Business Office Applications including Patient Registration, Third Party Billing and Accounts Receivable.
Provide direction and technical supervision to staff within Central Business Office and Patient Registration.
Ensures HR (competency) files are in place and up-to-date, meeting all TONHC Joint Commission requirements.
Recommend personnel actions such as promotion, reassignment or termination, awards.
Submit requests for personnel action timely.
Interviews applicants and recommends selections.
Hears and resolves employee complaints or refers to the next level for additional assistance.
Determines individual training and development needs and seeks out ways to satisfy them.
The incumbent is responsible for furthering the goals of Equal Employment Opportunity (EEO).
Foster a team effort.
Performs other job-related duties as assigned.