Member Services Billing Coordinator

Under the supervision of the Member Services Manager, processes claims and authorizations for qualifying members of Member Services programs offered the Paiute Indian Tribe of Utah. Coordinates collection and processing of claims. Provides backup support for Member Services Manager. Advises Member Services Enrollment Specialist on data entry standards for qualifying members. Assists with medical billing and coding where needed. Adheres to strict privacy policies protecting patient/client information.

Work Schedule:

Monday - Friday; 8:00 AM - 5:00 PM; 1 Hour Unpaid Lunch Break

Job Functions:

Include, but are not limited to, the following:

• Manages and maintains an accurate tracking system for PRC medical/dental invoices, purchase orders, and other areas requiring follow-up.
• Maintains strict confidentiality regarding protected health and personal information as required by HIPAA.
• Assists with PRC data entry into Athena or other applications as required for funding and financial recordkeeping.
• Process and manage claims and authorizations.
• Ensures data entry standards are upheld.
• Assists and coordinates mileage reimbursement with the Member Services Manager as requested and tracks, prepares, and closes purchase orders.
• Assists and coordinates monthly Medicare reimbursement checks and assures the checks are sent out in a timely manner. Serves as the point of contact for questions related to mileage and Medicare reimbursement checks.
• Tracks and follows up with vendors regarding outstanding purchase orders or a monthly basis.
• Works as an advocate for Tribal Members.
• Addresses Tribal Members and vendors regarding PRC policies/procedures, eligibility determination, referral process, payment for services, reimbursement for services and other related issues.
• Assists Business Office Coordinator on processing and re-pricing third party claims as needed in accordance with PITU policies.
• File vendor and patient claims in patient charts on a regular basis.
• Works as part of a team by participating in meetings as needed and other activities that promote efficient and effective communication between team members.
• Date stamps, sorts, and routes all mail received daily.
• Provides back-up support for the Member Services Manager.
• Performs other general administrative and office duties as assigned.
• Other duties as assigned to support the efficient operations of the Tribe.

Necessary Knowledge, Skills & Abilities:

• Basic knowledge of medical procedures and disease stages/processes.
• Demonstrated knowledge of federal regulations governing PRC operating procedures.
• Demonstrated knowledge of medical terminology, anatomy, and physiology.
• Exceptional flexibility and positive people skills.
• Willingness to learn new tools and technologies.
• Maintains a positive attitude.
• Comfortable working under tight deadlines.
• Ability to establish and maintain effective working relationships with all levels of the organization and community.
• Ability to manage and perform with a high degree of autonomy, organization, and adaptability.
• Must be able to demonstrate respect for and awareness of Native American customs, traditions, and socioeconomic needs.
• Must have excellent oral and written communication skills, including public speaking with large and small groups of different managerial, socioeconomic, cultural, ethnic, and educational backgrounds.
• Must be willing to travel as needed.

General Requirements:

• Must be insurable through the Tribe’s vehicle insurance required.
• Must pass a criminal and fingerprint background check according to P.L. 101-630 standards required.
• Must be able to pass an alcohol/drug screening required.

Education & Experience:

• High School Diploma, equivalent GED or higher required.
• One (1) year experience in prior authorizations, processing medical billing, healthcare, or insurance data required.
• Preferred one (1) year experience with insurance including Medicaid, Medicaid ACO’s, dental carriers, managed care, and third-party payer systems.

• Preferred understanding of Prior Authorization Services and/or Purchase Referred Care (PRC) processes.

License & Certifications:

• Must possess, maintain, and provide proof of a valid Driver License required.
• Must obtain, maintain, and provide proof of a valid CPC or equivalent certification within six (6) months of hire date required.

• Group Health Care Plan (Health, Dental, Vision, Life/AD&D and Long-Term Disability). Employer paid premiums for Employee, Spouse and Dependents
• Supplemental/Voluntary Benefits (Aflac, Life/AD&D and Short-Term Disability, Hospital Indemnity, Accident, Critical Illness)
• HSA Bank Account - Monthly employer contributions
• Retirement Plan (401k, Roth) - Dollar for dollar match up to 6%
• Paid Time Off
• Paid Holidays (Federal, State and Tribal) - Paid according to set work schedule only
• Paid Birthday Leave
• Paid Bereavement Leave
• Employee Assistance Program
• Education Assistance Program
• Wellness Program - Earn up to $1,000 into your HSA account per year