Nooksack Indian Tribe

Compensation

Full Description

Department: Health Department Reports To: Health Director Job Status: Full Time Type: Exempt Grade: J JOB SUMMARY: The role of this position is to manage, plan, direct, and coordinate the business activities of the Medical Business Office and supervise program personnel. Business activities include third-party billing and claims processing for outpatient medical services, as well as management of Purchased and Referred Care program. The position is responsible for supervising billing procedures, resolving complex billing issues, and providing work direction and overall performance management of the billing program. This role also ensures ongoing compliance with all Tribal, state, and federal regulatory requirements and standards. MAJOR TASKS AND RESPONSIBILITIES: • Oversee third-party billing operations including charge production, revenue, accounts receivable, and claims adjudication; analyze billing trends, insurance data, collections, and performance metrics to ensure accuracy, timeliness, and optimization of revenue. • Supervise and manage staff by delegating work, monitoring productivity, authorizing timesheets, conducting performance evaluations, coordinating training needs, and ensuring effective staffing for operational demands. • Ensure accurate and compliant billing practices by directing billing workflows, monitoring follow-up processes, resolving claim issues, and maintaining compliance with HIPAA, State/Federal regulations, payer requirements, and Medicare-Like Rates to prevent payment delays, including AIR payments. • Manage Purchased and Referred Care (PRC) program operations and staff, including verification of services, eligibility determination, rate application, and reconciliation of payments for referred medical services. • Develop, maintain, and enforce Business Office policies, procedures, and workflows, including user education, corrective action processes, and continuous improvement initiatives. • Provide advanced claims resolution through detailed research and use of multiple billing, auditing, and payer systems to resolve complex claim and payment issues. • Coordinate reporting and financial reconciliation with the Health Director, Finance Office, CFO, Comptroller, and accounting staff; prepare and present detailed operational and financial reports as requested. • Collect, compile, analyze, and audit billing and patient data using systems such as the IHS Registered Patient Management System; conduct routine and program-specific audits to ensure accuracy, compliance, and identification of improvement opportunities. • Manage payer, vendor, and regulatory relationships with various agencies including but not limited to, Washington State Health Care Authority, CompuHealth, Northwest Regional Council, and private insurers to stay current on billing regulations, system updates, and process changes. • Oversee provider credentialing and insurance access administration, including processing credentialing applications, managing payer portals, assigning system access, coordinating with QA staff, and ensuring timely insurance verification for claim submission. • Lead special projects and operational improvements, including process analysis, productivity measurement, resource assignment, and implementation of strategies to improve efficiency and outcomes. • Maintain professional competency and collaboration by attending required trainings, fostering effective working relationships with staff and stakeholders, and supporting a cooperative team environment. Ensure compliance with billing standard to include promptly notifying the program service manager of any errors or omissions in service claim requiring corrective action. • OTHER DUTIES: Because of the Tribe’s commitment to community service and the well-being of its members, each employee may be expected to perform a wide range of office and field duties from time to time. Such duties may or may not be related to their regular responsibilities. PREFERENCE • Indian Preference Policy applies to this and all positions with the Nooksack Indian Tribe. MINIMUM QUALIFICATIONS The following qualifications are required for the incumbent to have, in order to be considered for the position. REQUIRED EDUCATION, EXPERIENCE AND TRAINING FOR POSITION: • Bachelor’s degree in healthcare administration, business administration, finance, accounting, or a related field and a minimum of five (5) years of supervisory experience in medical billing, accounting, and supervision of personnel in a healthcare setting. or • Associate’s degree in healthcare administration, business, finance, accounting, or a related field and a minimum of seven (7) years of supervisory experience in medical billing, accounting, and supervision of personnel in a healthcare setting. or • High school diploma or GED and a minimum of nine (10) years of supervisory experience in medical billing, accounting, and supervision of personnel in a healthcare setting, including demonstrated advanced technical knowledge of claims processing, compliance, and revenue cycle operations. REQUIRED SKILLS/KNOWLEDGE/ABILITIES POSITION: • Must have advanced knowledge and training in the operation and utilization of computer systems and medical billing software application systems. • Must have working knowledge of International Classification of Diseases -10 (ICD10) and Current Procedural Terminology (CPT) coding principles and practice, or complete academic training courses in these two areas within 3 months of employment required. • Must be able to communicate clearly and legibly, orally and in writing. • Must adhere to federal privacy act and be in compliance with Federal HIPAA Laws and Regulations. • Must be dependable and able to work independently with little supervision. Must attend staff trainings and meetings as required. • REQUIRED CONDITIONS OF EMPLOYMENT: • Must pass alcohol/drug test at time of hire and throughout employment. • Must pass criminal background check at time of hire and periodically thereafter. THE NOOKSACK INDIAN TRIBES IS AN INDIAN PREFERENCE EMPLOYER-except as provided by the Indian Preference Act (Title 25, US Code, Section 473.