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Fiscal Intermediary

Gardnerville, United States

Position Title

Fiscal Internediary

Job Type

Full-Time

Classification

Non-Exempt

Grade

NE8 (13.49 - 18.88)

Department

Clinic Administration

Supervisor

Position Summary

Under direct supervision the Fiscal Intermediary is responsible for initiating medical authorizations and documents that are reviewed for patient information, clinical data and fiscal data. Maintains confidentiality of all privileged information.
Minimum Qualifications
  • High School Diploma or GED and two years experience in a medical billing setting and/or working with medical claims; or equivalent combination of education and experience.

  • Must be able to successfully pass a pre-employment drug/alcohol screen and background investigation.

  • Preference will be given to Qualified Native American Indians.

Essential Duties & Responsibilities
  • Determines patient eligibility for care under the Contract Health Services (CHS) Program in accordance with the Code of Federal Regulations “42 CFR, Part 36 § 36.23”.

  • Identifies patient eligibility for alternate resources.

  • Determines the priority for services provided under the CHS Program based upon established IHS priority guidelines.

  • Processes medical and dental claims.

  • Obligates funds into the commitment register is accurate accountability of funds and proper fiscal coding procedures and processes purchase orders payment.

  • Prepares denials based on applicable CHS regulations.

  • Monitors activities and records pertaining to the fiscal management of CHS funds.

  • Identifies and submits possible Catastrophic Health Emergency Fund “CHEF”, Diagnosis Related Group “DRG and Third Party Liability Cases.

  • Participates in Quality Assurance and Utilization Reviews during the Contracted Health Services Managed Care Committee meetings.

  • Processes claims on a daily basis.

  • Reviews claims for CHS eligibility, notification requirements, prior authorization, and coordination of benefits to determine appropriate action (i.e. clean claim process for payment, deny claim, return to provider to bill accounts receivable, pending compliance).

  • Provides technical assistance to management.

  • Explains and interprets regulations and policies to ensure appropriate use of Contracted Health Services and that there is a thorough understanding of the program policies and procedures.

  • Develops and implements CHS procedural guides, complies and interprets various alternate resources, references and guides.

  • Maintains an efficient and effective filing system.

  • Notifies provider as to the alternate resource(s) available to the patient to enable the provider to submit the claim to the appropriate alternate resources.

  • Answers telephone and personal inquiries regarding CHS eligibility and status of claims.

  • Compiles information and prepares for submission of periodic and special reports concerning CHS to the Business Office Manager.

  • Performs other duties as required.

Knowledge, Abilities, Skills, and Certifications
  • Knowledge of modern office practices, procedures, and equipment.

  • Knowledge of business English, proper spelling, grammar, punctuation, and basic arithmetic.

  • Knowledge of records management and basic accounting procedures.

  • Ability to effectively communicate orally and in writing in order to gather and exchange information with individuals both inside and outside of the organization.

  • Ability and skills to effectively interview patients in-depth in order to determine eligibility of alternate resources and funding.

  • Ability to be patient with the elderly and indigenous persons.

  • Ability to work with people from diverse cultures, ethnic and socio-economic backgrounds with knowledge of Indian community and sensitivity to Indian needs.

  • Ability to communicate effectively in the English language both verbally and in writing.

  • Ability to establish and maintain professional relationships with individuals of varying social and cultural backgrounds and with co-workers at all levels.

  • Ability to communicate effectively, including the ability to listen intently in working with Native Americans, their families and others.

  • Ability to represent the organization in a professional manner, building respect and confidence.

  • Ability to maintain confidentiality.

  • Ability to handle multiple tasks and meet deadlines.

  • Ability to carry out instructions furnished in verbal or written format.

  • Ability to work independently with minimal supervision.

  • Ability to demonstrate excellence in everything, and continually seek improvement in results.

  • Skill in operating business computers and office machines, including in a Windows environment, specifically Word, Excel, Access, and presentation software (such as PowerPoint).

Physical Demands
  • While performing the duties of this job, the employee regularly is 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 walk. The employee occasionally is required to stand; and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds.

Work Environment
  • Work is generally performed in an office setting with a moderate noise level.

  • The Washoe Tribe of Nevada & California requires a background check of each new hire for employment purposes. Therefore, all conditionally offered positions will be subject to the following:

  • Negative alcohol and drug screen

  • Meet requirements of Public Law 101-630

  • Obtain or possess a valid driver’s license for either the state of Nevada or California within 30 days

  • Must be insurable under the Washoe Tribe’s driving policy