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SUMMARY

This position is responsible for oversight of the day-to-day program budgets, billing, and revenue cycle processes with attention to billing outcomes and coding performance. This includes working with the billing company-TPA, department staff and providers, to ensure optimum billing and program budget performance for all GTB Health Sub-departments. This position will oversee the billing team that manage accounts, communicate with insurance companies, collections, payment posting, billing transactions and report creation. Showing accurate record keeping, timely filing, HIPAA and PHI compliance, Accounts Receivable, and budget reconciliation. The position is very computer intensive and must have knowledge of Data base development and management through several systems, including MS Office Suite, RPMS, TPA and PBM portal data. Understanding and familiarity with the GTB accounting billing system and general search engine skills are a must. The Revenue Cycle and Data Manager is responsible for reporting on program budgets, revenue cycle reports, and data analyst of key information driving the budgets, in coordination with the Health Administrator.

MINIMUM QUALIFICATIONS

• Bachelor's Degree in Business Administration or Finance.
• Thorough understanding billing, collections and payment posting, revenue cycle, & third-party payers.
• Thorough understanding of budget management and reporting for business planning and development, as well as program specific management and reporting.
• Thorough understanding of Database creation, data analysis, compiling and interpreting data from several systems.
• Two (2) to three (3) years' progressive and successful billing cycle and data management experience preferred.
• Must have a valid unrestricted driver license and be insurable by the GTB insurance carrier.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Oversee the day-to-day billing operations within the department with emphasis on front-end systems to ensure that all information provided to billing company is accurate and billed in a timely fashion.
• Assist billing team with review of Provider notes to ensure that all services rendered are billed properly.
• Responsible for driving process improvement initiatives related to front end revenue cycle functions in collaboration with billing company, clinic staff and Health Administrator.
• Identify opportunities for work process improvements with respect to billing and program management.
• Preparation of analytical reports.
• Identify revenue cycle problems and implement solutions for improvement.
• Assist Health Administrator to set goals and priorities for each area of concentration of responsibility for budget, revenue, and data analysis.
• Make recommendations for department policies, and programs.
• The Revenue Cycle and Data Manager will work with the Health Administrator and sub-department supervisors to prepare and oversee the development, implementation, and monitoring of fiscal year department budgets, preparing reports, including assisting in the preparation of annual budgets, and other Program Director duties for all GTB Health program budgets.
• Maintain patient confidentiality as per Health Insurance Portability and Accountability Act (HIPAA) of 1996 and complete HIPAA compliance training.
• Other duties as assigned by Healthcare Administrator.

OTHER SKILLS AND ABILITIES

• Must have excellent verbal and written communication skills.
• Must have excellent interpersonal skills with demonstrated patience, tact and respect.
• Must have exceptional detail and follow-up skills.
• Must have proven proficiency in computers, including Microsoft Windows Operating System and Microsoft Office Suite
• Skill in developing, implementing, and administering work processes.
• Detail oriented and tolerant of frequent interruptions and distractions from patients and staff.
• Effectively communicate with physicians, patients, insurers, colleagues and staff.
• Oversee billing, and accounts, ensuring accuracy and that company procedures are followed.
• Conduct analysis to understand growth and revenue drivers and motivations.

EDUCATION and/or EXPERIENCE

• Bachelor's Degree in Business Administration or Finance
• Must have excellent knowledge and experience of health billing processes for revenue generation and business management.
• Two (2) to three (3) years' progressive and successful management experience preferred.

OTHER QUALIFICATIONS

• GTB Program Director Training certified or to take the training.
• Must have attain working knowledge of CPT and ICD9 codes, HCFA 1500, UB04 claim forms, HIPAA (within 5 business days), billing and insurance regulations, insurance benefits and appeal processes, within 90 days-6 months;
• JCAHO accreditation knowledge.

DRIVING REQUIREMENTS

• Must have a valid unrestricted driver license and be insurable by the GTB insurance carrier.
• Must be willing to travel for continued training and education.

SUPERVISORY RESPONSIBILITIES

Responsible for the direct supervision of the GTB Health Services billing staff.

EQUIPMENT TO BE USED

Standard office equipment including desk computers, laptop, calculators, printers, fax machine, telephone systems, etc.

TYPICAL PHYSICAL DEMANDS

Work requires sitting, lifting, reaching, walking, and lifting heavy objects, such as a case of paper or several books at once. Also requires manual dexterity to operate office equipment, keyboarding, copiers, etc.

TYPICAL MENTAL DEMANDS

The complexity and responsibility inherent in this position requires performance with above average ability, calmly and decisively in response to the demands of the position. Work requires close attention to task for work to be accurately completed and be able to use judgment to respond to events several times a week. Medical coding aspect requires a high level of repetition that can be mentally draining

WORKING CONDITIONS

A good deal of work is performed in an office environment, but it is important to realize that some of the work is on the floor and in the other offices.

COMMENTS

Native American Preference will apply. Must be willing and able to pass a background investigation and a drug and alcohol urinalysis as a condition of employment. Adherence to strict company policy regarding confidentiality is a must

The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Management retains the right to add or to change the duties of the position at any time through approved motion by Tribal Council. * Any qualifications to be considered as equivalents in lieu of stated minimums require prior approval of the Director of Human Resources.

This position is subject to IC3 Background Investigation, Drug Screen and Driving Record/Motor Vehicle Report (MVR).