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Medical Billing Technician I II III (DHPI06) 

About the Organization Thank you for your interest in exploring the professionally rewarding and personally fulfilling benefits with Tuba City Regional Health Care Corp. We look forward to continuing our discussion about the opportunity and purpose health professionals experience as valued members of TCRHCC team.

A TCRHCC career offers a chance to live and work within or near Native communities, providing clinicians/nurses/administrators with a unique opportunity to learn the heritage of the tribes we serve, discover traditions that have been carried down for generations and gain cultural insight into the beliefs and values of a deserving and appreciative patient population.
 
Description

POSITION SUMMARY

This position has responsibility for a full range of technical services of billing functions that includes the oversight of properly executed claims on a timely basis to third party payers and responsible parties, and rebilling or correcting previously submitted billing of accounts. The incumbent determines the most accurate and descriptive codes in accordance with CPT/HCPCS coding guidelines set forth by the Health Care Financing Administration (HCFA) and other third party payers. The incumbent has regular and recurring contact with employees, patients, families, Contract/ Third Party Payers, Clinical Services Professionals and Administrative staff and constant contact with the Compliance Office, Utilization Review, and Insurance Institutions.

ESSENTIAL FUNCTIONS:

Technician I:

1. Receives and examines alternate resources of claims to assure claims are complete with appropriate supporting documents which typically include utilization review certifications. Responsible for transmission of all third party claims in a timely matter as specified by policy and procedures.

2. Verifies accuracy of patient account number, claim amount is authorized, and appropriate regulations, decisions, directives and other controlling guides allow items of services billed. Identifies errors, omissions, duplications in documents and contact the appropriate individuals to resolve problem.

3. Searches and abstracts all CPT, ICD9, and HCPCS coding and all other pertinent data from the medical records in order to identify and document appropriate patient care and other information necessary for billing.

4. Identifies inconsistencies or discrepancies in medical documentation by notifying the appropriate providers and/or all other departments within the facility for complete charge capture and abstraction. All providers and identified risk departments will follow-up to assure completion in compliance with hospital’s policy and compliance program. Keeps this system updated at all times to ensure accurate reports.

5. Consults with the attending physician, laboratory, radiology and all other necessary departments for compliance with all the regulations and guidelines pertinent to False Claims Act and Compliance program in preparation for itemized billing.

6. Reviews system generated reports daily to identify claims that are ready for billing. Prepares and submits claims to third party payers, intermediaries or responsible parties within 48 hours after all information for billing becomes available.

7. Responsible for the error correction for all rejected/suspended claims previously submitted to third party payers and intermediaries and patients according to hospital policy and procedures.

8. Responsible for keeping up to date with assigned payer billing rules and guidelines.

9. Performs other duties and responsibilities as assigned.

Technician II/III:

1. Responsible for super-user duties; researching and troubleshooting issues, assist with new system and process implementation, assist with system upgrades and testing, and complete system training certifications.

2. Perform case work duties such as in-depth research and maintaining of files related to workman’s compensation and motor vehicle accidents from open to closed cases. Communicates closely with employee, employer, payer, attorneys, and all others involved in each case. Submits and releases liens with county courthouses. Performs the negotiation process with all third party payers, intermediaries, and patients.

3. Performs all duties of Technician Level.

4. Performs other duties and responsibilities as assigned.

PROBLEM SOLVING

The incumbent performs complex, varied non-standardized tasks requiring applications of laws, regulations, Compliance Program policies and procedures. Uses a complex body of specialized subject matter knowledge and good interviewing or investigating techniques to assure accurate information is abstracted in a courteous and efficient manner. The billing process consists of duties that involve different and unrelated processes and methods. The complexity of the work involves working with various programs, covering several states and third party payers who have different benefits and remittance formats.

MENTAL AND PHYSICAL EFFORT

The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Physical:

The work is primarily sedentary; ability to lift up to 25 pounds, walk/stand for short periods of time; ability to stoop and pick up objects from the floor without restrictions, and have full use of hands and arms, i.e., to operate office equipment such as computer, printer, fax, etc.

Mental:

Exercises initiative and judgment in deviating from existing department or corporation practices to resolve billing issues/concerns. Work is reviewed for conformance to policies, procedures, and practices relating to billing practices.

IMPACT

The funds collected are used by the corporation for funding daily operations and expending capital projects, planning purposes, and core operations, which are essential to the overall objective of elevating the health status of Indian beneficiaries.  The successful efforts of the incumbent directly impact the funds collected and the financial viability of the medical center.

NAVAJO/INDIAN PREFERENCE

TCRHCC is located within the Navajo Nation and, in accordance with Navajo Nation law, has implemented a Navajo/Indian Preference in Employment Policy.  Pursuant to this Policy, applicants who are enrolled members of the Navajo Nation and who meet the necessary qualifications for this position will be given preference in hiring and employment for this position and applicants who are enrolled members of any other tribe who meet the necessary qualifications will be given secondary preference.

APPLICATION DECLARATION

In performance of their respective tasks and duties, all employees at TCRHCC are expected to conform to the following:

  • Adhere to all professional and ethical behavior standards of the healthcare industry.
  • Interact in an honest, trustworthy and dependable manner with patients, employees and vendors.
  • Possess cultural awareness and sensitivity.

All employees must uphold all principles of confidentiality and patient care to the fullest extent.

I have read the qualifications and requirements for the position of Medical Billing Technician I/II/III.  To the best of my knowledge, I believe I can perform these duties.

 
Position Requirements

NECESSARY QUALIFICATIONS

Education:

Technician I: Must have a High School diploma or GED equivalent.

Technician II: Must have a Medical Billing and Coding Certificate or certification in a related field.

Technician III: Must have an Associate’s Degree or higher in Business Administration or Hospital Administration or a related field.

Experience:

Technician I: Must have minimum of one (1) year experience related to medical, dental, and/or pharmacy billing and operations, and/or medical and dental coding, and/or patient access management, and knowledge of human anatomy and physiology and medical terminology.

Technician II: Must have minimum of three (3) years of experience related to medical, dental, and /or pharmacy billing and operations, medical and dental coding, or patient access management and knowledge of human anatomy and physiology and medical terminology.

Technician III: Must have five (5) or more years of experience and in-depth knowledge related to medical, dental, and/or pharmacy billing and operations, medical and dental coding, or patient access management, and knowledge of human anatomy and physiology and medical terminology.

Other Skills and Abilities:

A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas:

  • Positive working relationships with others
  • Possession of high ethical standards and no history of complaints
  • Reliable and dependable; reports to work as scheduled without excessive absences
 
Close Date 5/8/2021  
EOE Statement The Tuba City Regional Health Care Corporation (TCRHCC) is committed to equal opportunity employment. In accordance with the Navajo Preference in Employment Act (NPEA) and TCRHCC policy, preference is given to qualified Navajo and Native American candidates. Those applicants requiring reasonable accommodations(s) during the application and/or interview process should notify a representative in the Human Resources Department.  
Exempt/Non-Exempt Non-Exempt  
Full-Time/Part-Time Full-Time  
Location Tuba City Regional Health Care Corporation  
Navajo/Indian Preference Applicants who are enrolled members of the Navajo Nation and who meet the necessary qualifications for this position will be given preference in hiring and employment for this position.  
Open Date 2/26/2021  

This position is currently not accepting applications.

To search for an open position, please go to http://TubaCityRegionalHealth.appone.com



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