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Job Summary: Under the direction of the Revenue Cycle Director, plans, organizes and supervises the denial management and collection process of denied claims for TCC. Assumes supportive role to outside vendors related to the management of the denial process, other TCC departments and leadership. Maintains adequate staffing levels to effectively support the prevention of denials that negatively impact the revenue cycle performance of TCC.

Adhere to the TCC Ch’eghwtsen’ model of service and guiding principle which requires providing timely and effective service along with the ability to interact with others in a way that inspires trust and demonstrates respect, compassion and empathy.

Essential Functions: This list is ILLUSTRATIVE ONLY and is not a comprehensive listing of all functions and tasks performed by incumbents. Incumbent(s) may not be required to perform all duties listed and may be required to perform additional, position-specific duties. Under the direct supervision of the Revenue Cycle Director, job incumbent:

Representative Duties: Under the direct supervision of the Revenue Cycle Director, job incumbent:

1. Supervises and trains personnel assigned to resolve denials through work on the denial module. Monitors employee productivity and quality of work. Ensures continuous quality improvement to ensure a productive workflow, ensures compliance with all policies and procedures developed to prevent denials. Verifies the accuracy and timeliness of billing activities that influence denials and other problems
2. Plans, mentors, reviews and revises work assignments as necessary to meet department goals, in accordance with TCC policies. Interviews, selects and hires staff. Settles employee problems, disputes, and administers appropriate disciplinary action when necessary. Promotes teamwork and conducts weekly/monthly meetings with direct reports.
3. Supervises the timely follow up of denied claims from all commercial and contracted payers.
4. Works with Coding Manager to ensure that coding denials are addressed.
5. Works with Health Data Analyst to develop effective reporting and diagnostic tools.
6. Collaborates effectively with all Department Directors and staff to provide updates on new/updated processes, and to maximize revenue opportunities and ensures compliance with all applicable billing standards.
7. Manages the Denials Committee meetings by preparing and presenting new and on-going denials that exceed the standards identified for each category. Coordinates the efforts between all members/departments of the committee to meet the denials committee established goals.
8. Completes monthly/quarterly denial analysis and reports related to findings to the Denials Committee and leadership as needed.
9. Works with Department Directors and Coding Manager to monitor denials specific to billing deficiencies, develop and implement innovative methods to decrease denials that directly impact reimbursement for services rendered.
10. Assist Revenue Cycle Director with other assigned tasks/duties and reports as needed. These duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally either verbally or in writing.
11. Jointly develops annual program budget with the Revenue Cycle Director and manages program budget within TCC guidelines and funding limits.
12. Makes policy recommendations relating to Billing Office activities and third party billing, updates current policies as needed. Assures that proper billing guidelines, legal guidelines, federal and state rules are followed.
13. Obtains relevant training as needed to maintain applicable skills and knowledge.
14. Assures enforcement of Privacy Act requirements in all Billing Office activities.

Other Responsibilities:

1. Perform other job related duties as assigned.

Minimum Qualifications:

1. Accounting or Business degree. May be substituted for by years of experience in health billing administration at the discretion of the hiring manager.
2. Five years of billing office supervisory experience required.
3. Ability to use the following billing code systems: CPT, ICD10-CM, ADA, and use proper billing procedures.
4. Familiarity with third-party billing requirements necessary.
5. Intimate knowledge of Medicaid and Medicare billing requirements needed.
6. Is familiar with all areas of billing management information systems.
7. Prefer familiarity with IHS statistical reporting, tribal billing guidelines and special requirements.
8. Is familiar with and assures enforcement of Privacy Act requirements in all business office activities.
9. Must pass background check pursuant to the State of Alaska background check and federal Indian Child Protection and Family Violence Prevention Act requirements.

Knowledge, Skills and Abilities:

1. Effective oral and written communication skills required.
2. Proficient computer skillset to include: MS Word, Excel, and Outlook and familiarity with billing systems.
3. Program Development to include redesign of systems and processes to meet Management initiatives.
4. Strong organizational, analytical and problem solving abilities, and time management skills required.

Supervision: This position supervises all Billing Office staff

Physical demands: Work is primarily sedentary with some walking, bending and lifting. Will require some evening and weekend work. Incumbent is required to work effectively in a busy, sometimes stressful environment.

Summation: Incumbent must be able to maintain strict confidentiality. Incumbent works under minimal supervision. Supervisory skills with ability to deal with different situations are required of this position.

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