Business Office Clerk

Job Code: 29-2072 Salary: $15.63 - $31.68

Exempt: Non-exempt, Full-time, Permanent Location: Health Services

Department: Business Office Reports To: Business Office Manager

Telecommute: No Fleet: No

SUMMARY: Under the direction of the Business Office Manager, the Business Office Clerk will compile, process and maintain documentation for health care services in a manner consistent with medical, administrative, ethical, legal and regulatory requirements in all areas of the Business Office. The Business Office Clerk will assist in all areas of the Business Office with overall planning, coordination and management of the health care delivery system.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

· Answer telephone calls for all departments within the Business Office.

· Collection, sorting, and distribution of incoming daily mail for all Business Office Departments.

· Analyzes/processes health claims, records, and explanation of benefits that Outside Providers submit to the Resolve billing system for any unpaid balance to the Purchased Referred Care (PRC) program for payment of authorized/approved referrals, as needed.

· Review and verify purchase orders/payment vouchers/purchased referred care explanation of benefit statements/authorized referrals entered in the Resource Patient Management System (RPMS) for payment of balances owing for referred health care services.

· Prepare and mail letters of approval/denial for the purchased referred care program.

· Verifies/updates patient insurance and demographic information in the Resource and Patient Management System (RPMS)/Moonwalk and Aither billing system at patient registration, as needed.

· Creates purchase orders and payment vouchers for the Purchased/Referred Care program as needed.

· Posts third party insurance payments in the RPMS Accounts Receivables application as needed.

· Communicate and report complaints, problems and concerns to Business Office Manager.

· Able to deal with patient(s) sensitively and professionally at all times.

· Scans documentation for Business Office into the On Base electronic filing system.

· Assist Business Office Manager with provider credentialing and insurance contracting.

· Assists in the development and modification of Business Office policies and procedures.

· Attends meetings/trainings as requested by the Business Office Manager.

· Assures HIPAA compliance with regard to all Business Office practices.

· Annual review and scheduling of patients needing appointments for MSP reimbursement.

· Other related duties as assigned (including Patient Registration, Referrals, Health Information Management, Purchased/Referred Care, Accounts Payable/Receivable, and Third-Party Billing).

SUPERVISORY RESPONSIBILITIES: There are no supervisor requirements for this position.

QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Due to the sensitive nature of information and personnel files maintained within the Business Office, must maintain strict confidentiality at all times.

EDUCATION and/or EXPERIENCE:

· High school diploma/GED AND

· 1 year of medical office or billing experience.

· Certificate in Office Administration or related. PREFERRED

OTHER SKILLS and ABILITIES: Strong oral and written communication skills required. Must have excellent computer skills, including word and excel.

REASONING ABILITY: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

The Saint Regis Mohawk Tribe strives to be an equal opportunity employer dedicated to the policy of nondiscrimination based on race, sex, marital status, sexual orientation, religion, national origin, age, physical disability, veteran status or any other non-job related factor.

The successful candidate must pass a test for illegal substances prior to employment being confirmed.

The successful candidate must pass a criminal background check prior to employment.

The successful candidate must complete a PPD prior to employment.