Job Details

PLEASE NOTE - This position may require temporarily relocation to other TONHC Facilities: Sells Hospital, Santa Rosa Health Center, San Simon Health Center, and San Xavier Health Center.

Position Summary:

The incumbent is responsible for posting third-party (Medicare, Medicaid, and Private Insurance) payments and adjustments to the accounts receivable ledger (RPMS) in the Patient Accounts Section.

Scope of Work:

The position is located at the TONHC Hospital and Clinics. The incumbent works under the general supervision of the Business Office Manager or designee.

Essential Duties and Responsibilities: (Depending on the area of assignment, an incumbent may not be required to perform some of the duties listed below):

• Maintains accounts by reviewing documents to verify accounting data and entering data into the system.
• Reconcile accounts, compare account balances with related data to assure agreement, reviewing records and source documents to identify the sources of discrepancies.
• Prepares reports reflecting the examination made, discrepancies noted, and the corrective entries required adjusting accounts.
• Examine for accuracy of claims and other requests for payment for (1) services provided by TONHC; (2) reimbursement of expenditures made by beneficiaries and non-beneficiaries for such purposes as medical care and treatment.
• Maintains the automated accounts receivable ledger associated with third-party payer claims; responsible for associated records and documentation.
• Reviews and reconciles all third-party documents for correct data on all third-party vouchers for accurate claim numbers.
• Prepares weekly, monthly, quarterly and annual reconciliation and recapitulation of third-party billing to assure that collections, billed data, and the computerized and manual reports are in balance.
• Reviews and examines various bill types of patient care to third-party payers and performs third-party collection posting to the automated accounts receivable program.
• Receives and reviews all Explanations of Benefits and remittances from third-party payers. Identifies and records proper claim numbers on each remittance and posts them to the appropriate account.
• Responsible for posting all contractual/adjustments related to, and in conjunction with, posting payments per hospital policy and procedures. Monitors account balances, reviews postings to ensure accuracy, and recommends appropriate corrective action.
• Audits all documents received for completeness and accuracy; analyzes and selects guide to determine whether payments are full or partial per hospital policy and procedures; whether they are timely; and whether remittances are advances, installments, or supplements.
• Maintains current documentation and guidelines on reimbursement activities to appropriate files, binders, etc., and ensures preparation and distribution of copies to all applicable disciplines.
• Safeguard the alternate health insurance claims' resource program contents as privileged communication and disclosure of information only within TONHC policy limits.
• Completes special projects within the required timeframe to ensure compatibility of project specifications.
• Verifies the accuracy of payment history for the period involved and determines the extent of underpayment or overpayment.
• Responsible for assisting in the timely resolution of unidentified cash received by the hospital according to hospital policy and procedures.
• Maintains confidentiality when handling financial records or documents.
• Performs other job-related duties as assigned and contributes to a team effort.

Knowledge, Skills, and Abilities:

• Knowledge of the Tohono O'odham culture, customs, and traditions.
• Knowledge of applicable federal, state, tribal laws, regulations, and requirements.
• Knowledge of TONHC Internal Controls policies and standards for accuracy and timely posting.
• Knowledge of total program operation and the priorities and goals of the Alternate Resources program.
• Knowledge of current changes in policy regulations on eligibility.
• Knowledge of third-party payer reimbursement logic and the total accounts receivable management program.
• Knowledge and understanding of established and standardized accounting procedures and techniques sufficient to handle duties assigned.
• Knowledge of various accounting transactions and documents, accounting symbolic codes, account structures, and procedures for setting up and crediting accounts receivables.
• Working knowledge of ICD-10-CM, CPT, and HCPCS coding terms to interpret and resolve problems based on information derived from the accounts receivable reports.
• Knowledge of the established procedures, reimbursement formats, etc., associated with the various reimbursing third-party payers.
• Knowledge of automated systems, ability to type, and ability to operate a calculator.
• Knowledge of, and the ability to apply, the Alternate Resources regulations; P.L. 94-437, Title IV of Indian Health Care Improvement Act, Indian Health Service Policy and Regulations on Alternate Resources, CFR 42-36.21 (A) and 23 (F), and P.L. 99-272, Federal Medical Care Cost Recovery Act.
• Skill in providing superior customer service to external and internal customers.
• Skill in handling multiple tasks and meeting strict deadlines.
• Skill in operating various word-processing, spreadsheets, and database software programs.
• Ability to communicate efficiently and effectively both verbally and in writing.
• Ability to participate in planning, to implement, and improving the Accounts Receivable Program.
• Ability to establish and maintain positive and effective working relationships with other employees and the general public.
• Ability to work independently and meet strict timelines.
• Ability to maintain privileged and confidential information.

Minimum Qualifications:

• Associate's Degree in Business, Accounting or closely related field and two years' work experience in accounting, third party billing, financial recordkeeping, or an equivalent combination of training, education, and work experience that demonstrates the ability to perform the duties of this position.

Licenses, Certifications, Special Requirements:

• Must possess experience using Excel spreadsheets to create, prepare, and update accounting reports.
• Must type 40 WPM.
• Upon recommendation for hire, a criminal background and a National FBI fingerprint check are required to determine suitability for employment, including a 39-month driving record.
• May require possessing and maintaining a valid driver's license (no DUIs or major traffic citations within the last three years).
• If required, must meet the Tohono O'odham Nation tribal employer's insurance requirements to receive a driver's permit to operate program vehicles.
• Based on the department's needs, the incumbent(s) may be required to demonstrate fluency in both the Tohono O'odham language and English as a condition of employment.