Position Summary: Provide broad oversight for the Billing and Coding Departments ensuring proper training and compliance. Coordinate with outside insurance agencies and with HR for credentialing and re-credentialing of new or current providers. Oversee and lead in order to maintain all working systems, procedures and policies that effect the overall revenue cycle.

ESSENTIAL JOB FUNCTIONS: The list that follows is not intended as a comprehensive list, but rather to provide a representative summary of the major duties and responsibilities. Incumbent(s) will be required to perform a variety of duties listed, including but not limited to:

• Coordinates internal and external Billing and Coding audits. Coordinates the implementation of auditor recommendations.
• Provides Billing data and reports to the CFO. Develops and maintains a system for adjustment analysis, reviews and monitors all denials and works with the Billing Supervisor on follow ups and resubmittals.
• Coordinates with outside agencies on any outsourced Billing, Coding, and Accounts Receivable services.
• Makes determinations and participates in the development of policies and procedures regarding patient billing and coding, and collections to assure compliance with all Billing and Collection Laws.
• Coordinates with Billing Supervisor to schedule work assignments and planned time off of staff to meet essential reporting deadlines.
• Develops and provides in-house trainings to front office and support staff, records staff, and providers regarding administrative processes and procedures related to Billing and Coding. Coordinates with Site Managers to conduct such trainings at their respective sites.
• Maintains fee schedules within the EHR system.
• Remains current with ICD/CPT/and ADA coding guidelines and regulations.
• Maintain internal provider tracking system to ensure all provider information is accurate and logins are available.
• Complete re-validation requests issued by government and commercial payers
• Complete credentialing and re-credentialing applications to add providers to commercial payers, Medicare, and Medicaid
• Work closely with the Billing and Authorizations Departments to identify and resolve any denials or authorization issues related to provider credentialing.
• Maintain accurate provider profiles on ECHO, CAQH, PECOS, NPPES, and CMS databases
• Obtains the proper authorizing signatures on all official contract documentation.
• Coordinates with HR and IT upon the hiring of new providers to complete the credentialing process.
• Coordinates the completion of yearly reports required by OSHPD and other billing agency reports required for the facility or providers.
• Works with the CFO on the completion of the annual reconciliation reports.
• Performs other duties as assigned.

All NVIH employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by current NVIH’s policies and procedures.

REQUIRED QUALIFICATIONS

The following knowledge, skills, and abilities are required for an employee to successfully perform their duties.

• High School Diploma or GED
• 10 years’ experience in the Health Care or related field.
• Knowledge of provider credentialing and its direct impact on the practice’s revenue cycle
• Excellent computer skills including Excel, Word, and Internet use
• Advanced understanding of EHR concepts to include integrated software packages and databases.
• In-depth knowledge of the EHR Patient Registration, Third Party Billing and Accounts Receivable packages.
• Basic knowledge of computer security and data privacy concepts.
• Thorough understanding of federal laws and regulations regarding Indian Health Services’ eligibility regulations and rules.
• Effective Written and verbal communication skills.
• Able to organize, adapt and prioritize daily tasks independently.
• 5 years of direct experience in supervising and training employees.
• Effective interpersonal skills in maintaining work relationships and in guiding co-workers.
• Commitment to maintain confidentiality as it relates to patients and co-workers.
• Sensitivity to those with different lifestyles and to the Native American culture.
• Willingness to learn and to attend trainings as needed.
• Valid California Driver’s License.

Native Preference. Northern Valley Indian Health provides Native Preference in hiring practices for qualified Native applicants, in accordance with its policy. NVIH is also an Equal Opportunity and At Will Employer.
Job Benefits:

Medical, Dental, Vision, Life Insurance, 401K, 4 weeks PTO, 13 Holidays, Flexible Scheduling
From: Northern Valley Indian Health