What are the responsibilities and job description for the CHS Claim/Payment Support Specialist - CHS - Okmulgee position at Muscogee Creek Nation?
MINIMUM QUALIFICATIONS
Education – High School Diploma or GED equivalent is required.
Experience – One (1) year of relevant experience in medical billing or related field preferred.
Licenses & Certification – Must possess valid State of Oklahoma Driver’s License and be insurable.
Knowledge & Skills –
Knowledge of Contract Health Services (CHS), Indian Health Services (IHS) and Department of Health Administration Policies and Procedures.
Knowledge of third-party billing
Knowledge of general medical terminology and of the terminology used in the process of referrals.
Ability to prioritize and complete multiple work assignments in a timely manner.
Knowledge of the Privacy Act as it relates to confidentiality and release of medical information.
Knowledge of third-party resource programs.
Knowledge of patient registration systems and of the Health System in the provision of basic health service.
Skill in the use of a personal computer in a Windows environment and other office equipment.
Knowledge of data entry on an EHR database, word processing and the ability to utilize a personal computer in a Windows environment.
Ability to communicate courteously and effectively with patients and their families, MCNDH Staff and the general public via orally and in writing.
Ability to maintain a professional demeanor and maintain strict confidentiality.
JOB PURPOSE
The purpose of the position is to provide technical and financial support of the Contract Health Services. Incumbent is supervised by the Claims Supervisor. It also has responsibility in conjunction with the coordination of the staff within Muscogee (Creek) Nation Department of Health Clinic CHS Coordinators.
Provides financial management of services by researching and analyzing patient accounts for approvals, preparing and researching bills for payment and applying appropriate medical coding or contractual coding, processing medical claims in accordance with approval and eligibility.
JOB DUTIES
Processes medical claims.
Knowledge of eligibility issues and claim statuses.
Issues payments and checks to providers that have seen our patients with approved referrals/call-ins.
Receiving and process incoming call regarding claim status.
Analyzes and verifies patient referral information and any third-party billing resources, checking internal systems and third-party systems for eligibility e.g. Oklahoma Healthcare Website, Medicare, Private Insurance, etc.
Gathers and analyzes information from internal systems that includes medical systems for electronic health records and WADE/SPARC Contract Health System.
Protects organizations value by keeping information confidential and abiding by the HIPPA and Privacy act guidelines maintain strict confidentiality in regards to medical information and release of that information.
Assist Claims personnel with various activities, as required, including accessing and verifying Policyholder information, providing other information, entering claims information into the claims management system.
Scans and distributes refund checks to appropriate parties.
Communicate systems issues and overpayment to Claims Manager promptly.
Maintains an exemplary attendance.
Generates and distributes claims inquiry letters and refund request letters.
Updates job knowledge by participating in educational opportunities; reading professional publications; participating in professional organizations.
To perform any other duties as requested, or as become evident.
SKILLS/QUALIFICTIONS
Basic Accounting Principles, HIPPA Privacy Act Knowledge, Reporting Skills, Deadline-Oriented, Time Management, Attention to Detail, Confidentiality, PC Proficiency (MS Office Suite of Products), Productivity, Verbal Communication, General Math Skills, Customer Service, Team Player, Knowledge of Third-Party Administrator industry.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.
Benefits:
Health Insurance, 401K Plan