Kewa Pueblo Health Corporation

PO Box 559•85 West Highway 22§Santo Domingo, NM 87052§(505) 465-3060

• Uphold all principles of confidentiality and patient care to the fullest extent.
• Adhere to all professional and ethical behavior standards of the healthcare industry.
• Interact in an honest, trustworthy and dependable manner with patients, employees and vendors.
• Possess and maintain an environment of cultural awareness and sensitivity enabling the facility to fulfill its mission by meeting or exceeding its goals.
• Take responsibility for all day-to-day operations of the facility and health services provided to the patients.
• Maintain a current insurable driver’s license.
• Comply with all Kewa Pueblo Health Corporation and Santo Domingo Health Center policies and procedures, as well
• Consistently maintains professional and ethical standards adhering to all KPHC Policies, Compliance Standards and HIPAA.

• Managetheday-to-dayoperationsofthebusinessofficefunctionsofbillingandcollections with internal staff and 3^rd party RCM vendor.
• Participatesandassistsinthecoordination,datacollectionandmonitoringofallbusinessofficeactivities.
• Providesonsitesupervisiondemonstratingtheproperuseofapprovedpoliciesandprocedures.
• Providesbusinessofficeorientationtonewemployees.
• Ensures compliance with Tribal, Federal, state and other regulatory laws, which include provider contracts, PRC and supportagreements.
• Completesall management andpatientcarereportsaccuratelyandinatimelymanner.
• Oversee maintenance, updates of the relevant modules, set-up, and data tables in the electronic health record systems and related billing engines.
• Direct resolution of billing and payment issues and ensures proper communication between executive and leadership team.
• Ensure analysis and correction of root causes of denials, billing errors, database errors, etc. that result in non-payment or denied claims.
• Collaborate with other departments/programs to design systems, train staff, monitor and implement changes needed to ensure effective and timely revenue workflow.
• Resolve escalated reimbursement issues with payers.
• Direct the selection, supervision and evaluation of staff. Ensure performance evaluations are conducted in a timely manner.

• Ensure staff are educated on new technology, goals, and contracts.
• Establish and maintain departmental policies and procedures. Communicate relevant information to other departments. Recommend policy changes to the CFO.
• Create the department budget and monitor the budget throughout the year.
• Maintain extensive knowledge of revenue cycle and regulatory requirements associated with governmental, managed care, and commercial payers.
• Perform other duties as assigned.

• Abilitytoprojectrevenuereportsandforecastingregardingpatientbillingsandcollections usingvariousreports.
• Evaluate contractual allowance and bad debt allowance by payer on the monthly basis.

• Isknowledgeableof,andcomplieswith,allcodingandbillingguidelinesandrulesandregulationsofThird-Partypayers.
• Conducts a thorough review of all business office procedures, policies, and staff and revises procedure in a team approachandproblemresolutions.
• Assuresbilling followsFederalregulationsandcontractcompliance.

• Examines accounts to resolve difficult and complex reconciliation’s requiring an analysis of adjustments and correctiveentriesinthepatient account system.
• Trace transactions entered and prepared and/or provides supporting documents reflecting the sources of discrepancies,corrective action required to bring accounts into agreement, prove the accuracy of adjusted accounts, and recommendactionsto prevent recurrenceofsimilar discrepancies.
• ReviewsandexaminesvariousbilltypesandperformsThird-Partycollectionsprocessonallunpaidandpartialpaymentsoutstanding.
• Receives and reviews all Explanation of Benefits (EOB) and/or Remittance Advices (RA) from Third-Party payers that aredenyingpaymentfordiscrepanciesidentifiedwiththeseunpaidclaimsforresolutionsand/orpayments.
• Maintains documents of all activity related/performed on patient accounts in patient financial folder.Documentationwill include contact information such as dates, telephone numbers, name of person contacted, and status of paymentandinformation.
• MakereferralstoProviderContactRepresentativeforinterviewprocessforqualifications for other for other for otherforotherforotherThird-Partyresources.
• Responsible for identifying patient accounts deemed non-collectable.Generates and maintains appropriate documentsonsuch patient accountsandreferstoCFO for disposition.
• Prepares weekly, monthly, and annual reports utilizing the Accounts Receivable program.This would include reportinganyandalldiscrepanciesto the CFOwith supportingdocumentsand recommendingsolutions.

• Bachelor’sdegreein BusinessAdministrationorrelatedfield.

• Eight(8)yearsofworkexperienceinthirdpartyhealthcarebillingandcollectionsandFour (4)yearsofworkexperienceinasupervisorypositionin thirdpartyhealthcarebillingandcollections.
• Thorough workingknowledgeofrevenuecycle,coding,billingandcollectionsystems.
• Practical knowledge of payer-specific rules and regulations, including Medicaid and Medicare
• Knowledgeoffinancialreconciliations,managedcareprogramsand ACAlegislation. 

• Must be a certified Coder.
• Excellent communication and interpersonal skills including the ability to negotiate and resolve conflicts and build teams.
• Knowledge of medical terminology.
• Knowledge of healthcare billing codes (CPT, ICD-10, HCPCS).
• Knowledge and understanding of state and federal rules and regulations.
• Ability to operate in high-pressure situations.
• Excellent organizational skills, planning, and project management abilities.
• Demonstrated innovative approach to problem resolution.
• Broad knowledge of modern health care administration practices and principles.
• Effective analytical ability to develop and analyze options, recommend solutions and solve complex problems and issues.

• BilingualskillsinEnglishandthe Keresnativelanguage
• Prior experience working with Indian Health Services (IHS), a Tribe or Tribal organization in Business OfficeManagement.
• WorkingknowledgeofNextGen.
• Master’s degree in business, healthcare administration, or related field.