Technician

Title

Claims Technician (Temporary)

Category Administration Description

Position Summary :

The Claims Technician will receive and process Air, Ambulance and Medical claims for medically necessary services to qualified individuals in the managed health care plan administered by the Navajo Health Foundation / Sage Memorial Hospital (NHF / SMH).

This position provides support services to the Purchased Referred Care Department in maintaining a viable program that demonstrates compliance with policy and regulations.

This list of duties and responsibilities is illustrative only of the tasks performed by this position and is not all-inclusive.

Essential Duties & Responsibilities :

• Develop and maintain a working knowledge of Arizona Health Care Cost Containment System (AHCCCS) rules and regulations and the terms and conditions of all NHF / SMH Managed Care contracts.
• Determine third party payer resources and eligibility of individuals for NHF / SMH managed care program using all sources of information available, including the NHF / SMH computer system.
• Complete, maintain, compile, and report accurate manual and electronic documentation of all job-related activities in NAIHS system and spreadsheets.
• Participate in and attend all required in-services and educational programs to improve and / or learn job-related skills.
• Uphold all principles of confidentiality and patient care according to NHF / SMH policy and procedures.
• Maintain communications with IHS and non-IHS facilities regarding patient referrals.
• Maintain PRC files according to established filing system.
• Receive patient / vendor notifications for medical services.
• Participate in and contribute to NHF / SMH and departmental quality improvement initiatives.
• Gather information on sensitive PRC cases for eligibility, denials, appeals and submit to immediate supervisor for review / approval.
• Provide administrative support to the immediate supervisor.

Ambulance transports :

• Receives notifications for ambulance services for patients that are utilizing their services.
• Verify patients are in SMH PRC service area.
• Verify insurance information. If patients do not have alternate resources such as Arizona Medicaid, Medicare, private insurance, request for required documents (Proof of Residency, Alternate Resources and Certificate of Indian Blood).

send letters out to patients and to vendors. Record information into proper spreadsheets. Send correspondence to patients and vendors and update information in proper spreadsheets.

Scan documents in patient’s EHR

Transfers :

• Receive notifications for patients who are transferred out from SMH ED or other IHS facilities,
• Verify patient is in SMH service (same as above, record information into proper spreadsheets).

Medical / AMB / Flight claims :

• Verify patient is in our service area.
• Verify patient has insurance-Medicare, AHCCCS, private insurance.
• Verify patient has a Sage Hospital or IHS referral / notification on file.
• Verify patient meets PRC eligibility requirements.
• Verify vendor has documentation on file (W9) in our vendor listing.
• Verify claim as explanation of benefits (EOB) attached to the claim.
• If a patient has Medicare, SMH PRC will pay Medicare Coinsurance or deductible.
• Patients who do not have any insurance, NAIHS, HCPC codes are looked up utilizing the CMS website. Calculations are made according to the CMS website (utilizing the Wage Index / MLR for the UB04-0131-outpatient claims, Web Pricer / DRG for inpatient stays).
• Post payments into Meditech Expanse.
• Copies are taken to Finance for payment to be issued.

Knowledge, Abilities, Skills, and Certifications :

• Excellent customer relations and telephone skills is a necessity.
• Ability to work in a high stress environment performing tasks requiring attention to detail and precision.
• Ability to work independently and follow tasks given by supervisor.

Physical Demands :

While performing the duties of this job, the employee regularly is required to sit long periods of time. The employee frequently is required to walk, stand, bend, stoop.

The employee may occasionally lift and / or carry items weighing up to 25 pounds.

Work Environment :

Work is generally performed in an office with moderate noise level. Extended hours and irregular shifts may be required.

Position Requirements

Minimum Qualifications :

• High School Diploma or General Equivalency Diploma.
• Two (2) years of hospital, medical office, or other health care related experience, including familiarity with medical billing and terminology.
• Ability to speak the Navajo language, preferred.
• Must be able to successfully pass the Employee Health Program requirements and background investigation.

Full-Time / Part-Time Full-Time Shift Days Position Claims Technician Close Date 5 / 3 / 2024 Number of Openings 2 Exempt / Non-Exempt Non-Exempt Req Number ADM-24-00002 Open Date 4 / 22 / 2024 Location Navajo Health Foundation About the Organization Navajo Health Foundation - Sage Memorial Hospital, Inc.

is a private, nonprofit 501(c)(3) corporation. It is the first Native-managed private comprehensive health care system in the country, and has been managed since 1978 by an independent, entirely Navajo Board of Directors.

Sage Memorial Hospital is the only Native American hospital to hold both a license from the Arizona Department of Health Services and Accreditation from The Joint Commission.

The hospital campus is located on private land owned by the Presbyterian Church, within the Navajo Nation Reservation. The organization includes a Critical Access Hospital and outpatient clinic, and an outpatient clinic 28 miles away in Greasewood Springs, AZ.

EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.

This position is currently accepting applications.

Last updated : 2024-04-23