Business Office Manager

• Adhere to all professional and ethical behavior standards of the healthcare industry.
• Uphold all principles of confidentiality and patient care to the fullest extent.
• Maintain a current insurable driver’s license.
• Possess and maintain an environment of cultural awareness and sensitivity enabling the facility to fulfill its mission by meeting or exceeding its goals.
• Take responsibility for all day-to-day operations of the facility and health services provided to the patients.
• Consistently maintains professional and ethical standards adhering to all KPHC Policies, Compliance Standards and HIPAA.
• Interact in an honest, trustworthy and dependable manner with patients, employees and vendors.
• Comply with all Kewa Pueblo Health Corporation and Santo Domingo Health Center policies and procedures, as well

• This position oversees others within the Business Office, such as billers and and/or contractors.
• Ensures compliance with Tribal, Federal, state and other regulatory laws, which include provider contracts, PRC and support agreements.
• Provides business office orientation to new employees.
• Manage the day-to-day operations of the business office functions of billing and collections of third party insurance claims.
• Participates and assists in the coordination, data collection and monitoring of all business office activities.
• Maintains and disposes of records and files according to Health Center and regulatory policies and requirements.
• Ensures confidentiality, security and safety of all records according to current Kewa Pueblo Health Corporation policies and procedures and HIPAA.
• Completes all management and patient care reports accurately and in a timely manner.
• Provides onsite supervision demonstrating the proper use of approved policies and procedures.

• Ability to project revenue reports and forecasting regarding patient billings and collections using various reports.
• Due to the large expenditures under the incumbent's control, s/he must have a good working knowledge of revenue reconciliation processes to prepare budgetary/revenue documents under his/her control for the CFO and CEO.

• Assures billing follows Federal regulations and contract compliance.
• Searches and abstracts all multi-disciplinary coding, operative and therapeutic services and all other pertinent data from the electronic health records in order to identify and document appropriate patient care and other information necessary for billing.
• Receives and examines alternate resources claims to assure claims are complete with appropriate supporting documents which typically include utilization review certifications. Verifies accuracy of health claims number that claimed amounts are authorized, and that items of services billed are allowed by appropriate regulations, decisions, directives and other controlling guides. Identifies errors, omissions, duplications in documentation and contact the appropriate individuals to resolve problems.
• Is knowledgeable of, and complies with, all coding and billing guidelines and rules and regulations of Third-Party payers.
• Conducts a thorough review of all business office procedures, policies, and staff and revises procedure in a team approach and problem resolutions.

• Reviews delinquent patient accounts records, following up with responsible parties via telephone and correspondence according to organization policy and procedures.
• Reviews patient accounts to determine the status of account, making adjustments that require special analysis and prepares and processes a variety of documents necessary for the maintenance and follow up of all outstanding patient accounts using RPMS database.
• Performs contacts with Third-Party payers for amounts due, problem resolution. This function is performed on a timely basis, in accordance with Health Center policy and procedures and Third-Party payers’ standards.
• Makes referrals to Provider Contact Representative for interview process for qualifications for other for other Third-Party resources.
• Performs work consisting of examination for accuracy, adequacy of documentation, compliance with regulations, and justification of claims and other requests for payment for services provided by health center and reimbursement of expenditures made by beneficiaries and non-beneficiaries for such purposes as medical care and treatment.
• Trace transactions entered and prepares and/or provides supporting documents reflecting the sources of discrepancies, corrective action required to bring accounts into agreement, prove the accuracy of adjusted accounts, and recommend actions to prevent recurrence of similar discrepancies.
• Reviews and examines various bill types and performs Third-Party collections process on all unpaid and partial payments outstanding.
• Maintains documents of all activity related/performed on patient accounts in patient financial folder. Documentation will include contact information such as dates, telephone numbers, name of person contacted, and status of payment and information.
• Prepares weekly, monthly, and annual reports utilizing the Accounts Receivable program. This would include reporting any and all discrepancies to CFO with supporting documents and recommending solution.
• Responsible for identifying patient accounts deemed non-collectable. Generates and maintains appropriate documents on such patient accounts and refers to CFO for disposition.
• Receives and reviews all Explanation of Benefits (EOB) and/or Remittance Advices (RA) from Third-Party payers that are denying payment for discrepancies identified with these unpaid claims for resolutions and/or payments.
• Examines accounts to resolve difficult and complex reconciliation’s requiring an analysis of adjustments and corrective entries in the patient account system.

• Bachelor’s degree in Business Administration or related field.

• Eight (8) years of work experience in third party health care billing and collections and Four (4) years of work experience in a supervisory position in third party health care billing and collections.

• Comprehensive knowledge of Medicaid, Medicare and Private Insurance requirements and regulations.
• Ability to carry out business office duties, functions and responsibilities, as listed above.
• Working knowledge of revenue cycle, coding, billing and collection systems.
• Broad knowledge of administrative and technical functions or activities in health field, quality assurance and outpatient clinic setting.
• Knowledge of financial reconciliations, managed care programs and ACA legislation.
• Ability to supervise others.
• Ability to perform other duties as assigned.
• Incumbent may be required to work day, evening or holiday shifts.
• Supervisory experience in health operations based Business Office operations and policy development.

• Prior experience working with Indian Health Services (IHS), a Tribe or Tribal organization in Business Office Management.
• Bilingual skills in English and the Keres native language
• Working knowledge of RPMS.