Job description

This Position is Weekends Only.

Position Summary:

The CHS Clerk’s main priority is to explain policies to health service providers, patients, and Tribal personnel. Responsible for determining patient eligibility, for accounts receivable and contacting the patient to meet with Benefits Coordinator to ensure eligibility requirements are for CHS. Responsible for processing/correcting, resubmitting vendor HCFA’s to FI BC/BS for payment and any other assigned duties.

Duties:

• The CHS Clerk will review all referrals for patient demographics, clinical, fiscal data, then initiate and obtain medical authorizations with the Reno-Sparks Tribal Health Clinic Medical Director, Contract Health Care, and/or private insurance carriers. Verify insurance coverage for eligible patients prior to the Medical Director’s approval or denial.
• Functions in a liaison capacity to both vendors and recipients of Contract Health Services by telephone and through written correspondence. Effectively communicate and orient health service vendors, recipients, and Reno-Sparks Tribal Health Clinic personnel, to insure that there is a thorough understanding of the program policies and procedures.
• Collects emergence room visit information from patients reporting within time limit. Forwards notifications to the RSTHC Medical Director and other clinic nursing staff.
• Answers telephone and personal inquires regarding payment, patients admitted to other than IHS facilities, outstanding charges, eligibility, etc.
• Daily data entry of referrals in the RPMS computer system and EHR system for the Contract Health Service Committee/Medical Director for approval or denial.
• Prepares all CHS/PRC eligible referrals for review by RSTHC Medical Director for approval/denial of CHS/PRC funding.
• Review incoming bills from patients or vendors for payment processing. Assist all patients with inquiries related to non-paid bills from the SSU and RSTHC.
• Process all incoming bills for vendors for payment.
• Screen all incoming vendor’s bill and notify patient prior to processing if patient is eligible for an Alternate Resource to comply with that before payment is processed.
• Complete Purchase Order and mail to FI for payment. Ensure all documents are enclosed EOB’s form primary insurance.
• Return bills to vendors for incorrect CHSDA billing.
• Return bills to vendor with appropriate primary billing information.
• Responsible for correcting/entering vendor EIN information in the RCIS System for vendor payment.
• Responsible for correcting any incorrect HCFA’s received by FI BC/BS and contacting vendors to send in corrected information or correct information onsite and re-bill to FI BC/BS.
• Responsible for accurately entering payment data into RCIS System.
• Responsible for accurate data entry of patient demographics and makes needed error corrections in Clinic database.
• Inform prenatal patients to apply for alternative resources i.e.; Medicaid. Refer patients to the Benefits Coordinator.
• Contacts patients regarding Medicare, Medicaid and private insurance information of termination, eligibility status, and other related changes. Correspond with the Benefits Coordinator of eligibility status of alternative resources and other related references.
• Create forms, handouts and excel spreadsheets related to Contract Health Services. Such as specialty provider list with current address, phone numbers and types of insurances accepted in the practice.
• Maintain excel spreadsheet of daily referral entries and outcome.
• Assist with other related duties as assigned.

Minimum Qualifications:

• Must have a High School diploma or a GED.
• Must be able to type 45 wpm. Experience with basic office equipment. Computer skills are preferred.
• Knowledge of medical/dental terminology preferred.
• A working knowledge of Medicare, Medicaid, Private Carriers, Workman Compensation, Social Security, Federal Health Care legislation including Champus, Champus VA, and the Indian Health Care Improvement Act provisions.
• Must maintain patient confidentiality (HIPPA) on all patients.
• Must be able to work in a diverse minority environment, ability and skills to effectively interview patients in-depth in order to determine eligibility of alternate resources and funding. Must show demonstrated ability to be patient with the elderly and indigenous persons.
• Preference to qualified Indians will be given.
• Ability to meet and deal with a variety of internal and external customers.
• Ability to meet the physical demands of walking, standing, some lifting during the performance of normal duties.
• Must pass a pre-employment alcohol and drug screening and pass a PL 101-630 Indian Child Protection and Family Violence background check.
• Must pass a recent TB test.
• Indian preference applies.

PLEASE NOTE: Hiring preference will be given to qualified tribal members of Reno-Sparks Indian Colony followed by members of other federally recognized tribes. Must pass and comply with the HR Policy 164.905- PL101.630. The Reno-Sparks Indian Colony requires a designated candidate to successfully complete a pre-employment drug screen, criminal background check, and confirmation of professional references and certifications.

Job Type: Full-time

Pay: Up to $25.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Weekend availability
• Weekends only

Work Location: One location

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