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Title

Patient Services Compliance Supervisor 

Description

Job Summary

The Patient Services Compliance Supervisor is responsible to oversee Eligibility Coordinators and Referral Coordinators, as well as serve as back-up when necessary. All duties and responsibilities will be performed in accordance with the Yellowhawk Mission and Vision statement.

Essential Job Functions

  1. Verifying eligibility for services provided within Yellowhawk by ensuring patients meets all Federal Regulations and/or policies for obtaining services.
  2. Utilize federal regulations, Yellowhawk polices and implemented registration forms.
  3. Check and verify eligibility for any alternate resources covering services provided in the clinic
  4. Ensure accurate data entry into the data base.
  5. Obtain all demographic patient information and ensuring all mandated fields within the system are completed with accurate and updated information.
  6. Once eligibility for services and alternate resources are verified, ensure all updates or changes are communicated back accurately to the appropriate staff using current implemented processes.
  7. Supervised staff are responsible for checking in patients for their appointments and assisting medical at monitoring patients wait time within the waiting room.
  8. Work as a team in learning and teaching many aspects associated with this position as this role will affect Yellowhawk Tribal Health Center operations, patients, community and staff.
  9. Review and approve all consults/referrals ordered by providers timely. This includes review of patient's eligibility for services; last yearly update, third party coverage and checking prior medical records are requested and obtained by Referral Coordinators.
  10. Staff will serve as a patient advocate ensuring all requests are done timely so patient care is not jeopardized.
  11. Responsible to be proficient at knowing and ensure Eligibility Coordinators know Federal Regulation 42CFR with regard to services received within Yellowhawk Tribal Health Center.
  12. Proficient at making eligibility determination of Direct Care Only and Purchased/Referred Care and ensure Eligibility Coordinators learn and are held accountable to make accurate determination to protect Yellowhawk Tribal Health Center from any sanctions.
  13. Responsible to know and learn all Yellowhawk Policies and guidelines which affect Eligibility, such as Proof of Residency, Student Status, etc. and ensure supervised staff know these as well.
  14. Responsible for understanding Yellowhawk priority guidelines and effectively verifying those priorities are followed in the referrals being created in each ordering department.
  15. Prior to approving access to PRC funds to outside referrals for patients, verify orders have documented medical necessity, the order is within the current funded priority, patients' eligibility is accurate, patient is up to date and third party insurance is current (Compliance).
  16. Responsible for Referral Coordinators pending referrals are worked on a daily basis and tracked on spreadsheet.
  17. Monitoring/maintaining pending monthly and quarterly report to Yellowhawk CFO.
  18. Responsible to understand multiple important mandates under 42CFR with regard to 'payer of last resort' and 180 day rule have ensure Eligibility Coordinators are proficient as well.
  19. Responsible to oversee and ensure all patients which submitted a current registration form and which has had a change to their Yellowhawk Eligibility Status, receives their eligibility letter timely and gets scanned into Vista in Electronic Health Record.
  20. Responsible to assist Eligibility Coordinators in tracking any Yellowhawk Tribal Health Center Pending Eligibility status and notify appropriate staff.
  21. Responsible to oversee and ensure any Eligibility or Insurance changes are distributed according to processes and done so daily or as soon as possible.
  22. Responsible to oversee and ensure tracking and logging of any upcoming Yellowhawk eligibility changes in Outlook and/or send out request letters for documentation of support for a determination.
  23. Responsible to learn and know the Indian Health Service (IHS) programs such as RPMS/EHR with regard to accurate demographic information and oversee Eligibility Coordinators know these programs as well.
  24. Responsible to know and oversee that Eligibility Coordinators know and understand Insurance types and benefits such as (Medical, Pharmacy, Dental, etc.), and know and understand basic language and acronyms with regard to insurance.
  25. Required to know and oversee Eligibility Coordinators can work with patients and utilize on-line eligibility tools to verify Insurance coverage for patients. (MMIS, Availity, OneHealthPort, etc.)
  26. Must lead by example and lead their team to work with all departments and learn together to be experts on rules and regulations with regard to all data entry entered into the RPMS/EHR.
  27. Responsible to work with the Yellowhawk Outstation Outreach Worker to assist in ensuring Yellowhawk patients have coverage.
  28. Complies with all HIPAA regulations and ensures staff.
  29. Other duties as assigned.
 
Position Requirements

Minimum Qualifications

  1. High School diploma or equivalent required
  2. Minimum three (3) years’ of successful medical office experience
  3. Minimum one (1) year of experience working directly with Insurance carriers
  4. Minimum one (1) year of supervisory experience or training in supervisory skills with experience in being the back up of a supervisor
  5. Knowledge and familiarity of Indian Health Services required
  6. Knowledge of Insurance types and terminology required
  7. Must have or obtain HIPPA training certification within first year of employment
  8. Proficient in Microsoft Word and Excel
  9. Demonstrated excellent customer service experience in a fast-paced help desk or customer contact environment
  10. Demonstrated strong verbal and written communication skills, including presentation skills
  11. Must possess a valid driver’s license and maintain insurance requirements to operate General Services Administration Vehicles
  12. Must submit to and pass a reference and criminal background check
  13. Must submit to and pass a pre-employment drug and alcohol screening
  14. Must submit proof of COVID-19 vaccination

Preferred Qualifications

  1. Experience working in a Tribal Healthcare setting preferred
 
Closing Date June 2, 2022 at 4:00 PM  
Supervised By Business Office Manager  
Salary $51,936 - $77,967 annual  
Covered Status YES  
Safety Sensitive NO  
EOE Statement No employee or job applicant shall be discriminated against in the pursuit of employment due to Race, Color, Religion, Sex or National Origin or any other category protected by law, except as provided by the Indian Preference Act under Title 25, of the U.S.C.  

This position is currently not accepting applications.

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



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