Healthcare Business Office Director

About the role

The Healthcare Business Office Director will be responsible for day-to-day fiscal and administrative operations of the Business Office Department's billing and healthcare fiscal reimbursable divisions. This position will also serve as a main point of contact in communication with other Directors, Leadership, and other related programs exploring healthcare services that may be seeking potential revenue avenues.

Responsibilities

• Supervises the Healthcare Business Office Administrative Staff, including Purchased & Referred Care (PRC), Billing & Coding, Healthcare Credentialing, and Tribal Assister/Benefits Coordinator employees
• Works closely with Healthcare Department Directors and/or appropriate staff to ensure clinical delivery services are billed appropriately and accurately
• Provides educational materials, forms, and fee schedules on proposed services
• Provides guidance and recommendations on current processes that may affect third party revenue
• Participates in staff and program meetings, which include consultation, supervision, and professional training sessions
• Works directly with patients to discuss issues and to find solutions that pertain to the Healthcare Business Office, including PRC, Tribal Assister Program, and Third-Party Billing
• Provides and develops training for Third Party Revenue, and Contract Health Services
• Assures that Business Office employees, Clinic, and Behavioral Health and Lummi Counseling Services employees are appropriately trained in accessing insurance portals, maintaining active logins, resetting logins, and training on how to use the portals
• Works directly with patients and LIBC Health employees to discuss questions or concerns about their referrals, patient bills, and help guide patients through their insurance information to help educate the patient
• Studies and standardizes procedures to improve efficiency of subordinates
• Develops, submits, and monitors operation budgets and expenditures
• Assures that best practices are observed consistently by staff through training, in-services, and specific direction; establishes or recommends new policies and procedures as necessary
• Works with the Lummi Indian Business Council, the Lummi Health & Family Services Commission, and other requested entities, as requested
• Regularly ensures payment for claim dues for pharmacy and clearinghouse submissions
• Coordinates and participates in Teams and Zoom meetings
• Submits JIRAs to communicate EPIC software needs to resolve issues, when needed
• Travels or participates in online relevant conferences, trainings, and meetings, when requested
• Reviews and approves timecards and time sheets in ADP

Third Party Billing

• Works closely with the Billing Supervisor, Coding Supervisor, Contracting & Reimbursement Supervisor, and Patient Registration staff to ensure collections of all third-party resources
• Schedules regular meetings for managers to discuss potential training needs or updates on new processes
• Participates in regular billing webinars affecting changes to current billing standards
• Works as a team to establish productivity standards to maintain up to date billing standards
• Provides regular updates on data quality assurance within health programs for any changes to CMS rules and regulations to stay in compliance
• Analyzes information pertaining to the Business Office Department, and provides potential solutions with the guidance from Lummi's Office of the Reservation Attorney's Office for:
  • Establishing contracting guidelines with health insurance companies
  • Establishing policy and procedures with any new implementation of Federal Laws that may pertain to Tribes
  • Reviewing any potential legal cases to protect Lummi Nation's best interest
• Shall efficiently follow guidelines for reporting as required by Federal, State, Local and Tribal regulations or laws that pertain to the Healthcare Business Office Department
• Manages, approves, and unlocks security logins for all healthcare LIBC employees that need to request access to software to verify insurances, such as One Health Port, Availity, United Healthcare, Healthcare Management Administrators, and Delta Dental
• Analyzes EPIC Work Queues (WQs) regularly to ensure billing, coding, and accounts receivable accounts are maintained and worked regularly
• Fixes WQ baskets that need to be fixed, such as Masterfile issues or error pool issues
• Updates master files within EPIC Production and EPIC TXT Production, including adding referring providers, updating taxonomy codes/NPIs, and whether providers are servicing/billing providers

Purchased & Referred Care (PRC)/Tribal Assisters Program

• Reviews current Purchased & Referred Care (PRC) policies annually and updates to meet the needs of the Lummi Nation
• Regularly reviews workloads and processes of PRC program and referrals to ensure appropriate
• Works directly with other staff such as Referral Supervisor, Tribal Assisters and Benefits Coordinator Supervisor to assure payor of last resort policy is applied to PRC and to capture all potential revenue and cost savings
• Prepares data for each program to show patient enrollments for the Sponsorship Program, Medicare/Insurance Reimbursements, and Patient Travel Expenses
• Prepares reports out of EPIC on enrollment data
• Prepares PRC travel transportation and gas card per diems per PRC Policy Manual for eligible patients that need arrangements outside of PRCDA, as needed
• Audits and provides recommendations on PRC processes for internal and external processes to improve communication with vendors
• Attends LIBC Health Insurance meeting to discuss current reserve balances, benefits packages, and providing recommendations to cost options and other discussions that can help the Lummi Nation's best financial interest when it comes to health business discussions
• Communicates with HMA/AHT Insurance Representatives to maintain PRC eligible patients on processing claims to MLR adjustments
• Recommends changes to reports submitted to PRC program
• Develops educational materials to educate the community
• Manages NW Pharmacy Services (NWPS) to update patient information and problem solve current issues with updating this software and training new hires on improving this system
• Works directly with patients and/or pharmacies to resolve any override issues, insurance updates, and any other questions pertaining to getting a prescription filled at an outside pharmacy through NWPS

Credentialing & Accounts Receivable

• Authority to execute contracts with insurance companies to provide a higher reimbursement rate on all third-party resources
• Provides Month End Reports for the third-party reimbursement program with LIBC Accounting Department
• Develops monthly statistical reports and control methods in determining accounts receivable and collections
• Analyzes past and projected reports and provides recommendations to help improve potential revenue
• Uses relevant information and individual judgment of application and process to ensure we are following laws, regulations, or standards
• Manages and maintains an Authorized Representative for the National Council for Prescription Drug Programs (NCPDP), which allows us to stay credentialed with all pharmacies
• Maintains the National Provider Identifiers for the Lummi Nation Health Departments (Medical, Dental, Pharmacy, Mental Health, and Chemical Dependency)
• Maintains the National Practitioner Data Bank (NPDB) as an administrative user

Qualifications

• MBA in business administration, accounting or finance or Master of Healthcare Administration
• Certified Coding Specialist (CCS), Certified Professional Coder (CPC), similar credential, or Certification in Billing & Coding
• Ten (10) years of experience in healthcare administration or administration setting, which includes 6 years of supervisory experience
• Ten (10) years of experience in working with IHS/Tribal revenue cycles
• Ten (10) years of experience in coding and billing
• Ten (10) years of experience working with Medicaid, Medicare, and private health insurance requirements and regulations
• Lummi/Native American/Veteran preference policy applies

Knowledge, Abilities And Skills

• Ability to maintain strict confidentiality in all work-related areas consistent with the Lummi Nation's Policies
• Good understanding of reimbursable insurance procedures and requirements including ability to interpret provisions of individual health plans and group plans
• Knowledge of computer applications to include Word, Access, Excel, PowerPoint, and MIP Accounting System
• Good communication skills both verbal and written
• Ability to work independently and establish priorities
• Attention to detail and accuracy

Requirements

• Must pass pre-employment and random drug and alcohol test to be eligible for and maintain employment, as required by the LIBC Drug & Alcohol-Free Workplace Policy
• This position is subject to extensive Criminal Background Check
• Must have reliable transportation

Benefits

• Medical
• Dental
• Vision
• 401k
• Life Insurance
• Annual Leave
• Sick Leave
• Lummi Fitness Center Membership
• 19 Paid Holidays

Benefits available after successfully completing 90-day orientation.

This response is AI-generated, for reference only.