Revenue Cycle Analyst

Revenue Cycle Technician

Department: Finance

Program: Revenue Cycle

Reports To: Revenue Cycle Manager

Employment Status: Full Time

FLSA Status: Non-Exempt

Schedule: 40 hours/52 weeks

Preference: TERO Ordinance 2017-01, P.L. 93-638

Job Summary

The Revenue Cycle Technician will be crossed trained to perform a variety of duties. Some of these duties will be understanding payer requirements; identifying payer issues accurately and develop a plan to resolve these issues; follow-up on outstanding balances and take necessary action to ensure timely resolution; read and understand an "Explanation of Benefits" (EOB), identify trends in billing and address concerns in order to expedite payment; work denials, credit balances, missing payments, payer recoupments, and unposted cash as it pertains to billing account follow-up.

Essential Functions

• Verification of appropriate Current Procedural Terminology (CPTs) and modifiers
• Ensure the coordination of claim activities on various insurance portals and via phone to check claim status and resolve claim issues
• Verifies insurance payment is in alignment with payer contract by reviewing the contract status log and EOB received
• Research and resolve insurance denials
• Identify reason for claim rejections and complete proper action to ensure timely billing
• Supports leadership with daily, weekly monthly reporting needs as required and maintain third-party logs
• Identifies, researches and resolves: credit balances, missing payments, payer recoupments, and unposted cash as it pertains to billing account follow-up
• Processes and maintain correspondence received from patients and insurance companies as it pertains to correct and timely billing of claims, and receipt of payment
• Handles submission of issues to coding for review to ensure organizational and revenue cycle processes are followed
• Communicates appropriately with insurance companies, patients, co-workers and supervisors
• Ensures compliance with Tribal, federal, state, and local employment laws and regulations, Tribal policies and TERO ordinance

It is the intent of this job description to highlight the essential functions of the position; however, it is not an all-inclusive list. The incumbent may be called upon and required to follow or perform other duties and tasks requested by his/her supervisor, consistent with the purpose of the position, department and/or the Kenaitze Indian Tribe's objectives.

Working Conditions

Lifting Requirements

• Sedentary work Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met

Physical Requirements

• Stand or Sit (Stationary position)
• Use hands/fingers to handle or feel (Operate, Activate, Use, Prepare, Inspect, Place, Detect, Position)
• Talk/hear (Communicate, Detect, Converse with, Discern, Convey, Express oneself, Exchange information)
• See (Detect, Determine, Perceive, Identify, Recognize, Judge, Observe, Inspect, Estimate, Assess)
• Repetitive Motion

Hazards and Atmospheric Conditions

• Exposure to Fumes
• Exposure to Dust
• Noise

OSHA Categories

• Category III Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid

Equipment and Tools

List Equipment used for job: Computer, Telephone, Copier, Printer, Calculator

Travel

• Local
• Out of State

Qualifications

Education

• Associate degree preferred or a combination of education and experience in a related field may be substituted for a degree.

Experience

• One year (1) of experience in Tribal Medical Billing, Federally Qualified Health Center (FQHC) Billing, or related work

Preferred

• AAPC, Certified Professional Coder& Biller (CPC, CPB, COC), Certified Revenue Cycle Specialist (CRCS), Certified Revenue Cycle Specialist (CRCP), Certified Revenue Integrity Professional (CRIP)
• Knowledge and experience working with cultural diversities

License/Certification

• Must have a valid Alaska State driver's license and must remain insurable under the Tribe's policy, or obtain within 90 days of hire, or, with approval of the hiring manager, sign a *Memorandum of Understanding (MOU) in lieu of having a driver's license to perform the required duties of the position

Special Skills

• Proficiency with Microsoft Suite, or obtain training within 90 days of hire
• Conducts business in a service-oriented manner that is attentive, pleasant, respectful and kind when dealing with un'ina, visitors, co-workers and others
• Ability to multi-task, work independently, and meet deadlines

This position is a Covered Position subject to all requirements of the Alaska Barrier Crimes Act (ABCA) and to the Indian Child Protection and Family Violence Prevention Act, (ICPA). ABCA and ICPA requirements apply and must be complied with at all times in order to remain in the position.

*Memorandum of Understanding: Serves as documented evidence that the Kenaitze Indian Tribe has expressed the ineligibility of an employee to operate motor vehicles owned, leased or rented by the Kenaitze Indian Tribe, or to operate a personal vehicle on behalf of the Kenaitze Indian Tribe.