• Job Description

  Req#: 4986090
  The Third-Party Billing & Collections Manager works with the Executive Director of Health to plan, organize, direct, coordinate, and lead personnel and work process of a multi-million dollar program that serves the Tribal membership residing in Pima and Maricopa counties. The scope of responsibility includes the management and supervisory level of the Billing & Collections Unit. Incumbents at this level require a broad knowledge of Medicare, Medicaid, and Commercial Insurance regulations and billing processes, third-party billing insurance, grants, and/or governmental accounting principles and practices and are responsible for billing/collection and other related functions to ensure the financial integrity of the Health Service Division. The incumbent will serve as the Project Officer for any billing outsourcing to third parties. The Third-Party Billing & Collection Manager will be responsible for the supervision of line-level staff.
  1. Supervises staff including prioritizing and assigning work, conducting performance evaluations, ensuring staff are trained, ensuring that employees follow policies and procedures, maintaining a healthy and safe working environment, and, making hiring, termination, and disciplinary recommendations.
  2. Provides health, behavioral, dental, and other billing and collections for the Health Service Division, by maintaining account receivables schedules, tracking and reviewing confidential paperwork, editing and preparing various reports, verifying insurance eligibility, researching outstanding billing issues, and providing quality control for third party billing and collections related services.
  3. Prepares and submits APEP applications to AHCCCS for licensed providers for their Provider Identification.
  4. Prepares and submits applications to Medicare for approved licensed providers.
  5. Maintains Provider File within Ability Portal and other Third-Party systems.
  6. Maintains Insurance Files in E.H.R Systems such as RPMS, CT1, Eagle Soft, and Alltrans.
  7. Develops and prepares appropriate documents and forms to assist with payment requests for patient services, including but not limited to correspondence, patient charts, and/or summaries as directed; researches and verifies information for inclusion; and employee training and development.
  8. Reviews daily bank account deposits, and reconciliations for assigned accounts; ensures appropriate correcting or adjusting entries are made.
  9. Verifies client information to facilitate the billing and enrollment of eligible individuals.
  10. Responds to requests for sensitive information and assistance; provides information regarding applicable rules, policies, and regulations; resolves billing concerns and complaints; refers inquiries as appropriate.
  11. Develops and maintains billing policies and procedures for compliance with regulatory requirements, operations, and staff activities.
  12. Assists other programs and individuals with projects to implement new billable services.
  13. Advises supervisor and providers of deficiencies in information related to billing documents and claims.
  14. Attends various trainings for the department as needed.
  15. Performs other duties of a similar nature or level.
  16. Perform other duties of a similar nature or level as requested by the supervisor or director.
  17. Identifies opportunities to improve billing efficiency and accuracy and implement strategies to achieve these goals.
  18. Monitors Reports to ensure clean claims submissions.
  19. Monitors A/R aging and payment reports to identify outstanding claims.
  20. Maintains patient accounts by posting payments, adjustments, and denials.
  21. Manages the resubmission processing of claims to appropriate third parties.
  22. Completes assigned projects in coordination with management.
  23. Attends weekly Revenue Cycle Meetings and other as deemed necessary.
  Knowledge of:
  • Supervisory principles and evaluating employees; Budgetary principles;
  • Accounting principles and practices;
  • Medical, Behavioral, Dental, and Transportation billing and collections operations and best practices;
  • Customer service principles;
  • Developing a professional rapport with outside medical providers and billing companies;
  • Recordkeeping principles;
  • Report preparation techniques;
  • Effective communication through written, verbal, and interpersonal skills with employees, clients/members, or representatives of the tribe:
  • English language, grammar, and punctuation;
  • Applicable federal, state, and local laws, rules, and regulations;
  • Medical coding standards, such as CPT procedures and ICD-10 diagnosis coding; and HCFA 1500, UB04 and Dental ADA;
  • Medical tracking and reporting software, including but not limited to electronic systems for processing third-party insurance billing, in the E.H.R systems (i.e., RPMS, CT1, Alltrans, etc.);
  • Insurance eligibility and enrollment requirements;
  • Patient confidentiality by controlling the information being disclosed to authorized individuals ensuring compliance with all HIPAA compliance standards, as well as accepted confidentiality standards;
  • Grant research and funding sources;
  • Advanced mathematical concepts, including statistical analysis and comparison;
  • Medical terminology;
  • Manual and/or electronic systems for processing third-party insurance billing;
  • Yaqui culture, customs, resources, and traditions, and/or a willingness to learn.
  Skills and Abilities:
  • Assist in the direction and coordination of department operations.
  • Perform difficult mathematical computations.
  • Manage and execute multiple tasks.
  • Maintain various confidential records.
  • Prioritize and assign work.
  • Operate a variety of office equipment, including a computer and related software applications, telephone, fax machine, and adding machine.
  • Maintain files and records.
  • Develop and prepare a variety of business correspondence, records, reports, documents, and forms.
  • Provide quality customer service.
  • Ability to understand applicable Federal, State, and commercial payer requirements, standards, regulations, or laws; as well as all organizational policies and procedures related to healthcare billing and payment processing to include the guidelines regarding billing, documentation, and compliance.
  • Prepare and proofread a variety of reports and/or other documentation.
  • Communicate effectively; interpersonal skills as applied to interaction with coworkers, supervisors, the general public, etc. ability to exchange or convey information and to receive work direction.
  • Management/supervision practices and techniques.
  • Fund accounting as it relates to non-profit entities.
  • Principles, practices, theories, and procedures of accounting.
  • Financial record keeping and reporting procedures.
  • Automated accounting systems and applicable software applications.
  • Modern office practices and procedures.
  • Tribal budgetary and accounting practices.
  A Bachelor’s degree in a business, accounting, finance, or related field; Minimum of 5 years’ experience in billing, minimum of 5 years of supervisory experience; Coding Certificate
  
  Special Requirements:
  • Must possess and maintain a valid Arizona Driver’s License;
  • Coding Certificate
  • This position will require the incumbent to work non-traditional hours, nights, and weekends.
  • Must have a current Level 1 Arizona Clearance Card or obtain the Level 1 Arizona Clearance Card within ninety (90) days of hire. Failure to maintain a current Level 1 Clearance Card will result in removal from this position.

• About the company

  Official Website of the Pascua Yaqui Tribe of Arizona

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