Posted: Friday, December 29, 2017 8:32 PM
SUMMARY: Position shall be responsible for initiating, tracking, and processing "payer of last resort" health insurance claims according to United Indian Health Services (UIHS) Contract Health Services (CHS) guidelines. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned. Maintains Contract Health Service files. Determine if incoming CHS referrals are within the UIHS approved priorities. Ask for assistance from the Patient Accounting Manager when needed. Prepare and follow up on referrals that need medical and dental review. Determines if clients meet Contract Health Services eligibility requirements, including referral to Alternate Resources for screening and application if eligible. Also acquire a copy of Indian documentation for the CHS file. When necessary, contact outside providers to set up appointments for approved cases, ask for an estimate of charges, and notify clients of scheduled appointments. Create purchase orders for eligible approved referrals. Communicates and corresponds with outside agencies and clients regarding claim submission. Communicates and corresponds with clients/providers regarding status of Contract Health Services claims. Communicates and corresponds with UIHS providers to clarify Contract Health Services referrals and address case status questions. Tracks Contract Health Services cases through the processes of: appointment, procedural scheduling, outcome, third party insurance eligibility determination, and final claims payment processing. Tracks and submits claim reimbursements through Contract Health Services. Prepare and submit Catastrophic Health Emergency Fund (CHEF) cases following guidelines from IHS. Notify supervisor of possible pending CHEF cases so they can be reported to the Patient Registration/CHS committee. Prepares periodic reports on claims reviewed, pending, and processed to completion.
• Location: Arcata, Humboldt County
• Post ID: 8828417 humboldt