Purchased Referred Care and Billing Specialist

Bois Forte Band of Chippewa
5344 Lakeshore Drive Nett Lake MN, 55772 218-757-3261/1-800-221-8129

PURCHASED REFERRED CARE AND BILLING SPECIALIST

Opens: May 23, 2024
Closes: June 05, 2024

Department: Health & Human Services Reports to (title): Business Office/Purchased Referred Care
Manager

Job Code: N 10 Job Location: Bois Forte Tribal Government- Nett Lake

Pay Range: Min $17.02 Mid $21.28 Max $25.53 Supervises: No

Hours/week: 40 Classification: Non-Exempt

Type of Position: Full-Time Effective Date: 01/11/2024

Indian Child Protection
Background:

No Revised Date: 01/11/2024

PERFORMANCE EXPECTATIONS

In performance of their respective tasks and duties all employees of Bois Forte Band of Chippewa are expected to conform to the
following:

• Uphold all principles of confidentiality to the fullest extent.

• Adhere to all professional and ethical behavior standards of the tribal government (may also be referred to as “Band”).

• Interact in an honest, trustworthy, and respectful manner with employees, community, visitors, and vendors.

• Comply with Bois Forte Band of Chippewa policies and procedures.

• Display respect and understanding of Bois Forte Band of Chippewa traditions and values.

POSITION PURPOSE

The Purchased Referred Care and Billing Specialist provides support and technical assistance for payments, co-pays, denials for
the Purchased Referred Care Program. Also performs functions related to third-party billing services for Health Services to
include the areas of Medical, Dental, and Family Services programs, which may result when health care services are delivered by
the facility to consumer clients. Duties include the submission of properly executed claims on a timely basis to third-party payers
and responsible parties and rebilling or correcting billing of accounts previously submitted.

ESSENTIAL DUTIES, FUNCTIONS, & RESPONSIBILITIES

1. Reports to TPBS/PRCC the information to submit the Catastrophic Health Emergency Fund (CHEF) cases, as necessary.

2. Assist to ensure that patients keep alternate resource activities by serving as a contact for PRC Program.

3. Displays a positive and professional manner in promptly responding to all requests, complaints, and problems.

4. Demonstrates courtesy, respect, and sensitivity to the needs of all others including visitors and co-workers.

5. Knowledge of the PRC Program and services including an awareness and understanding of the purpose, objectives,
commitments, and priorities to perform both recurring and special assignments.

6. Knowledge of various third parties such as Medicare, Medicaid, private insurance, etc., availability of health care
resources, rules of eligibility for medical and other available programs to assist in payment of health care costs.

7. Knowledge of medical terminology and medical care practice procedures.

8. Receives and examines alternate managed care resources claims to ensure claims are complete with appropriate
supporting documents, which typically include utilization review certifications. Verifies accuracy of health claims and that
that claimed amounts are authorized, that items of services billed are allowed by appropriate regulations, decisions,
directives, and other controlling guides. Identifies errors, omissions, duplications in documentation and contacts the
appropriate individuals to resolve problems.

9. Identifies inconsistencies and/or discrepancies in medical documentation by notifying the appropriate providers and/or

other departments within the facility for complete charge capture and abstraction. All providers and identified risk

departments will follow-up to ensure completion, in compliance with the policy and utilization review/compliance

program.

10. Prepares and distributes billing demands on third-party eligible patients receiving health care services.

11. Acts as a contact person for insurance billing companies; notifies the insurance carrier within the required timeframe to

ensure service and reimbursement processing; and contacts insurance companies when an error in payment or

provider write-off is identified.

12. Develops, implements, and monitors billing policies and procedures for programs that provide billing activities;

transmits billing for reimbursement to the State for targeted case management services; and ensures all billing sheets

are submitted for billing and paperwork sent for payment posting.

13. Implements provider enrollment and updates for medical, dental, pharmacy, CD and MH, ensuring all providers are

added to all systems - Advantage, EHR, Dentrix and McKesson.

14. Documents insurance information on clients.

15. Prepares reports for management to aid in the analysis of revenue generated and submits adequate and timely reports

upon request and when necessary.

16. Follows data privacy guidelines and safeguards for reimbursement claims and medical records; maintains

confidentiality and professional ethics at all times.

17. Updates all paperwork needed for medical and dental clinics.

18. Ensures all data entry is completed in a timely manner including data entry for medical, dental, CHR, PHN, MH, CD and

referrals.

19. Contacts managed care companies for authorization when needed; tracks dates of services, paid and unpaid.

20. Works cooperatively as part of a team and promotes teamwork with co-workers.

21. Engages in on-going assessments to ensure quality of service is being provided.

22. As an employee of the Bois Forte Reservation, will follow the Bois Forte Procurement Policy and any other applicable

procurement requirements when obtaining goods and/or services for the Bois Forte Band of Chippewa.

23. Performs other duties as assigned.

MINIMUM MANDATORY QUALIFICATIONS

Experience: • One year of experience in medical third-party billing.

Education: • High School Diploma.

License/Certification: • None.

Mandatory Knowledge,
Skills, Abilities and
Other Qualifications:

• Knowledge of and the ability to apply the Alternate Resource regulations; P.L. 94-437, Title IV

• Knowledge of the total Alternate Resources Program operations, priorities, and goals.

• Knowledge of all third-party claims submission process and ability to keep current on changes

• Knowledge of ICD-9, ICD-10 and CPT IHCPCS coding procedures, Uniform Hospital Discharge

• Knowledge of how to establish and maintain relationships with the third-party payer

• Knowledge of the on-line input terminal equipment and automated electronic billing

• Knowledge of the EHR and the accounts receivable management program. Keeps abreast of

• Knowledge of billing functions, exporting clean billable claims to third-party payers.

• Ability to analyze complex medical and regulatory information to arrive at the most logical and

• Ability to exercise considerable tact in maintaining effective work relationships with various

• Excellent communications skills are required for training of staff on changes through

• Knowledge and familiarity with the utilization review/compliance program rules and

• Knowledge of how to establish and maintain relationships with the third-party payer

• Experience in EHR, Dentrix and McKesson, and purchased referred care.

• Knowledge of Privacy Act of 1974, HIPAA, and the use of confidential information and health

• Strong computer applications skills.

• Ability to deal with conflicting situations in a patient and sensitive manner.

• Ability to meet deadlines and prioritize workload.

• Strong verbal and written communication skills.

• Ability to work effectively with minimal supervision.

• Must have strong organizational skills.

• Must have reliable transportation.

• Ability to travel in and out of state.

• Basic operation of a workstation (turning on/off, knowledge of basic functions and

and passwords. Computer-related problem-solving skills through the use of available training
and help desk.

• Knowledge of Microsoft Office Suite (Word, Excel, etc.), internet software and appropriate

• Ability to perform other duties as assigned.

• A record of satisfactory performance in all prior and current employment as evidenced by

PREFERRED QUALIFICATIONS

• Associates degree in Business Management or related field.

WORK ENVIRONMENT

Work environment: The work environment characteristics described here are representative to those an employee
encounters while performing the primary functions of this job. Normal office conditions exist, and the
noise level in the work environment can vary from low to moderate. Limited overnight travel may be
required from time to time. This position may be exposed to certain health risks that are inherent
when working within a health center facility, such as potential exposure to hazardous chemicals,
sharps and infectious body fluids.

Physical demands: The physical demands described here are representative of those that must be met by an employee to
successfully perform the primary functions of this job. While performing the duties of this job, the
employee may be required to frequently stand, walk, sit, bend, twist, talk, hear and perform repetitive
motions. There may be prolonged periods of sitting, keyboarding, reading, as well as driving or riding in
transport vehicles. The employee must occasionally lift and/or move up to 50 pounds. Specific vision
abilities required by this job include reading, distance, computer, and color vision. Talking and hearing
are essential to communicate with the community, visitors, employees, and vendors.

Mental demands: There are a number of deadlines associated with this position. The employee must be able to handle
frequent interruptions and must also multi-task and interact with a wider variety of people on various
and, at times, complicated issues.

TRIBAL AND INDIAN PREFERENCE

The Bois Forte Band of Chippewa has implemented a Tribal and Indian Preference in Employment Policy. Pursuant to this Policy,
applicants who possess the knowledge, skills, and abilities required by this position, and who are enrolled members of the Bois
Forte Band of Chippewa Tribe will be given primary preference in hiring and employment for this position. Members of other
federally recognized Indian tribes will be given secondary preference for hiring and employment after providing proof of tribal
membership. Tribal and Indian preference is integrated into the interview and scoring process for candidates for job positions.

OTHER

Confidentiality: All employees must uphold all principles of confidentiality to the fullest extent. This position has
access to sensitive information and a breach of these principles will be grounds for immediate
termination.

Background
Investigation:

This position may be subject to a criminal history background check, a suitability background check
and/or a Fair Credit Reporting Act (FCRA) check. In addition, some positions are subject to a 101-630
background check in an effort to ensure compliance with Public Law 101-630 “Indian Child Protection

and Family Violence Prevention Act.” Candidates must be able to successfully pass all required
background checks to qualify for this position.

Drug Screening: All applicants must successfully pass a pre-employment drug screening prior to beginning
employment and will be subject to random drug testing.

PRE-EMPLOYMENT DRUG TESTING APPLIES. INDIAN PREFERENCE WILL APPLY. UPON PRESENTATION OF DD-214 WHICH
REFLECTS HONORABLE DISCHARGE, APPLICANTS WILL RECEIVE VETERAN’S PREFERENCE POINTS. Please visit our
website at www.boisforte.com to complete an application. Applications are accepted via: Fax, Email, U.S. Mail, and In
Person. Submit applications to: Human Resources Specialist 5344 Lakeshore Drive, Nett Lake, MN 55772, Fax: 218-757-
6781, hrgeneralist@boisforte-nsn.gov Applications received after the closing date will not be accepted.