The Wah-Zha-Zhi Health Clinic provides funded Medical/Dental referral care for its patients in the way of outpatient, inpatient, emergency and extended care services. This position is to assure an efficient and timely system of managed referral care to patients. Position will be responsible for review and obligation of referrals. Position will evaluate, analyze and provide reconciliation of referrals and obligation of funds.

• High School Diploma or GED required; Associates Degree in Health Information Management, Business Administration, Accounting, or other related healthcare fields preferred.
• Minimum of one (1) year of experience in Health Care billing, Accounting, Health Information Management, or a Referral Care Program required
• Requires knowledge of reimbursable insurance procedures and requirements including ability to interpret provisions of individual health plans and group plans
• Must have working knowledge of basic medical terminology
• Knowledge of electronic medical record system
• Must be able to review medical records in order to determine medical necessity
• Must have knowledge of filing procedures and medical records format
• Must possess a comprehensive knowledge of the private insurance payment system
• Requires thorough knowledge of the Privacy Act of 1974 and HIPPA regulations
• Requires knowledge of the operation of health care financing, programs, health care service contracts and agreements and the coordination of benefits
• Must have general knowledge of the contract care model of health care services delivery including utilization review, re-admission and concurrent review criteria and discharge planning
• Requires knowledge of the principles and methods of sound management practices including proper channels of communication, prioritization and participative management
• Requires knowledge and experience with various health care delivery systems including inpatient, outpatient, emergency care and specialty care processes, diagnostic categories and current treatment modalities
• Must have knowledge of private insurance billing practices to ensure prior authorizations, primary payers, and secondary payers
• Requires knowledge of patient care case management
• Must maintain a professional attitude and appearance that positively represents the Nation
• Requires a high level of personal integrity and ethics
• Requires a high level of problem solving skill
• High Attention to detail
• Requires willingness and ability to learn new skills, including travel to conferences and training sessions
• Must maintain confidentiality at all times
• Requires ability to use Microsoft Office Suite programs
• Requires good interpersonal communication and team work skills
• Must be able to pass a criminal background check
• Must be able to pass drug/alcohol testing
• Must have a clean driving record – may be required to drive GSA or tribal vehicles
• Other duties as assigned by supervisor