Since 1970, IHC has provided high-quality and compassionate healthcare and supportive services to the nine (9) American Indian consortium in north San Diego county. With more than 200 employees serving 2 clinic sites, IHC is proud of the diversity of its staff as a reflection of the community it serves.

The reward of working at IHC is more than a paycheck and excellent benefits; it is the impact and contribution to the Tribal community that employees value most. If you are passionate about improving the overall health and wellness of our tribal community, IHC is looking for people like you.

Native Preference in hiring is given to qualified enrolled members of our consortium, federally recognized tribes, and California Indians in accordance with the Indian Health Council’s policy. Applicants claiming Indian Preference must submit verification of Indian certified by tribe of affiliation or other acceptable documentation of Indian heritage.

Indian Health Council, Inc. (IHC) is committed to a diverse and inclusive workplace and as such, we are an equal opportunity employer and do not discriminate on the basis of race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status.

Job Title: Medical Insurance Billing / Collection Representative
Department: Business Operations
Reports To: Director of Revenue Cycle Management
FLSA Status: Non-Exempt
Job Function: Non-clinical
Classification: Regular, Full-Time, 40 hours/week
Schedule: Monday-Friday 8:00am-4:30pm
Location: Onsite (Valley Center, CA)
Benefits: Eligible for benefits on date of hire. Low employee contribution for PPO Medical, DPPO Dental, Vision. 403B retirement plan with company matching; generous PTO & sick time; 13 paid holidays annually, Employee birthday paid day off; bereavement and jury duty paid time off; company paid life, AD&D, short term and long-term disability; Eligible for company paid CMU, CEU, CPR and required licensures. Corporate discount programs. Monthly employee appreciation events. Service award program. Birthday and work anniversary acknowledgments.

SUMMARY:
Performs all aspects of Revenue Cycle Management on all government claims including CMS, Medi-Cal, VA and CHAMPVA

ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Other duties may be assigned.
1. Address and respond to all aspects of rejections, denials, claim inquiry format and refunds for governmental entities.
2. Continual analysis and quality control of underpayment risk areas to ensure audit accuracy.
3. Prioritize inquiries from CMS (Medicare) and DHCS (Medi-Cal) and from Director to assist with project specifics and reporting.
4. Auditing of all DHCS and report dual claim statistics to RCM director and CFO.
5. Work with Coders to ensure compliance with all claim requirements.
6. Attend all CMS and Revenue Cycle Management workshops.
7. Posts payments and adjustments into the Patient Management System. Reviews and interprets EOBs.
8. Actively works Accounts Receivable. Follows up on submitted claims; monitors unpaid claims, initiates tracers; resubmits claims as necessary.
9. Answers billing related inquiries and researches account discrepancies. Participates with other staff to seek account resolutions.
10. Updates patient account information and verifies completeness of insurance data.
11. Submits refund requests with supporting information and works credit balances.
12. Interacts professionally with insurance and payer liaisons.
13. Responsible for keeping current with new information/changes regarding insurance regulations, benefits coverage, and billing requirements.
14. Maintains strictest confidentiality. Uses, protects and discloses patients’ protected health information
(PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
15. Attends staff and department meetings.
16. Performs other related duties as requested.

SUPERVISORY RESPONSIBILITIES
This position does not have supervisory responsibilities.

TRAVEL & DRIVING REQUIREMENTS
Travel and driving are not required for this position.

QUALIFICATIONS
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.

LANGUAGE SKILLS
Ability to read, analyze, and interpret documents. Possess adequate written and oral language skills to communicate clearly and effectively. Ability to respond appropriately to the most sensitive inquiries or complaints. Ability to create and deliver effective presentations to public groups, peer groups and/or leadership.

MATHEMATICAL SKILLS
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to calculate figures and amounts such as discounts, interest, proportions, percentages, and volume. Ability to apply concepts of basic algebra and geometry.

REASONING ABILITY
Ability to apply principles of logical thinking to a wide range of intellectual and practical problems. Ability to deal with a variety of abstract and concrete variables. Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to apply critical thinking skills to problem solve.

PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee frequently is required to stand. The employee is occasionally required to walk and stoop. The employee must regularly lift and/or move up to 10 pounds; may frequently lift and/or move up to 25 pounds, and occasionally lift and/or move up to 50 pounds. The employee is occasionally required to drive. Specific vision abilities required by this job include close vision, peripheral vision, and ability to adjust focus.

WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Normal office environment.

CUSTOMER RELATIONS
1. Responds promptly and with caring actions to patients and employees. Acknowledge psychosocial, spiritual and cultural beliefs and honor these beliefs.
2. Maintain professional working relationships with all levels of staff, clients and the public.
3. Be part of a team and cooperate in accomplishing department/organizational goals and objectives.

QUALITY MANAGEMENT
1. Displays knowledge of normal signs of human development and ability to assess and provide age-appropriate care.
2. Contribute to the success of the organization by participating in quality improvement activities.

SAFETY
1. Maintain current knowledge of policies and procedures as they relate to safe work practices.
2. Follow all safety procedures and report unsafe conditions.

HIPAA/COMPLIANCE
1. Maintain privacy of all patient, employee and volunteer information and access such information only on a need-to-know basis for business purposes.
2. Comply with all regulations regarding corporate integrity and security obligations.
3. Report unethical, fraudulent, or unlawful behavior or activity.

Indian Preference shall be given in accordance with IHC’s Policies and Procedures.

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.