Business Office Manager

Business Office Santo Domingo, New Mexico


Description

Kewa Pueblo Health Corporation

                             PO Box 559    85 West Highway 22  §  Santo Domingo, NM 87052  §  (505) 465-3060

 

Business Office Manager
Department:                     Business Office
Reports to:                        Chief Financial Officer (CFO)
FLSA Status:                    Exempt
Type of Position:              Full-Time
Revised Date:                    05/08/2024
 
MISSION & VISION STATEMENT:
 
The Kewa Pueblo Health Corporation (KPHC) is established for the purposes of carrying out the vision and mission of the Santo Domingo Health Center (SDHC). The MISSION of KPHC is:  “ENSURING HEALTH & WELLNESS THROUGH EXCELLENCE IN HEALTHCARE WITH RESPECT FOR CULTURE” and the VISION OF KPHC is:  “HEALTHY PEOPLE, HEALTHY COMMUNITY, and HEALTHY LIFESTYLE”.
 
POSITION PURPOSE:
 
The Business Officer Manager reports to the CFO and is responsible for overseeing and coordinating all revenue cycle activities with a goal of maximizing reimbursement in a cost-effective manner that is in compliance with federal, state and payer-specific billing requirements. This position will be responsible for developing, monitoring, and assessing revenue metrics to refine processes, improve performance, and meet departmental KPI’s. The Business Office Manager will also work closely with the electronic health record team, leadership and 3rd party RCM vendor to develop and implement systems, training, and internal controls to ensure billing systems and processes comply with relevant regulations.
 
 
PERFOMANCE EXPECTATIONS: 
In performance of their respective tasks and duties all employees of the Kewa Pueblo Health Center are expected to conform to the following:
  • Uphold all principles of confidentiality and patient care to the fullest extent.
  • Adhere to all professional and ethical behavior standards of the healthcare industry.
  • Interact in an honest, trustworthy and dependable manner with patients, employees and vendors.
  • Possess and maintain an environment of cultural awareness and sensitivity enabling the facility to fulfill its mission by meeting or exceeding its goals.
  • Take responsibility for all day-to-day operations of the facility and health services provided to the patients.
  • Maintain a current insurable driver’s license.
  • Comply with all Kewa Pueblo Health Corporation and Santo Domingo Health Center policies and procedures, as well
  • Consistently maintains professional and ethical standards adhering to all KPHC Policies, Compliance Standards and HIPAA.
 
ESSENTIAL DUTIES, FUNCTIONS & RESPONSIBILITIES:
Administrative 
  • Manage the day-to-day operations of the business office functions of billing and collections with internal staff and 3rd party RCM vendor.
  • Participates and assists in the coordination, data collection and monitoring of all business office activities.
  • Provides onsite supervision demonstrating the proper use of approved policies and procedures.
  • Provides business office orientation to new employees.
  • Ensures compliance with Tribal, Federal, state and other regulatory laws, which include provider contracts, PRC and  support agreements.
  • Completes all management and patient care reports accurately and in a timely manner.
  • Oversee maintenance, updates of the relevant modules, set-up, and data tables in the electronic health record systems and related billing engines.
  • Direct resolution of billing and payment issues and ensures proper communication between executive and leadership team.
  • Ensure analysis and correction of root causes of denials, billing errors, database errors, etc. that result in non-payment or denied claims.
  • Collaborate with other departments/programs to design systems, train staff, monitor and implement changes needed to ensure effective and timely revenue workflow.
  • Resolve escalated reimbursement issues with payers.
  • Direct the selection, supervision and evaluation of staff. Ensure performance evaluations are conducted in a timely manner.

 

  • Ensure staff are educated on new technology, goals, and contracts.
  • Establish and maintain departmental policies and procedures. Communicate relevant information to other departments. Recommend policy changes to the CFO.
  • Create the department budget and monitor the budget throughout the year.
  • Maintain extensive knowledge of revenue cycle and regulatory requirements associated with governmental, managed care, and commercial payers.
  • Perform other duties as assigned.
 
 
Accounts Receivable 
  • Ability to project revenue reports and forecasting regarding patient billings and collections using various reports.
  • Evaluate contractual allowance and bad debt allowance by payer on the monthly basis.
 
Billing
 
  • Is knowledgeable of, and complies with, all coding and billing guidelines and rules and regulations of Third-Party payers.
  • Conducts a thorough review of all business office procedures, policies, and staff and revises procedure in a team approach and problem resolutions.
  • Assures billing follows Federal regulations and contract compliance.
 
Collections
 
  • Examines accounts to resolve difficult and complex reconciliation’s requiring an analysis of adjustments and corrective entries in the patient account system.
  • Trace transactions entered and prepared and/or provides supporting documents reflecting the sources of discrepancies, corrective action required to bring accounts into agreement, prove the accuracy of adjusted accounts, and recommend actions to prevent recurrence of similar discrepancies.
  • Reviews and examines various bill types and performs Third-Party collections process on all unpaid and partial payments outstanding.
  • Receives and reviews all Explanation of Benefits (EOB) and/or Remittance Advices (RA) from Third-Party payers that are denying payment for discrepancies identified with these unpaid claims for resolutions and/or payments.
  • Maintains documents of all activity related/performed on patient accounts in patient financial folder. Documentation will include contact information such as dates, telephone numbers, name of person contacted, and status of payment and information.
  • Make referrals to Provider Contact Representative for interview process for qualifications for other for other for other for other for other Third-Party resources.
  • Responsible for identifying patient accounts deemed non-collectable. Generates and maintains appropriate documents on such patient accounts and refers to CFO for disposition.
  • Prepares weekly, monthly, and annual reports utilizing the Accounts Receivable program. This would include reporting any and all discrepancies to the CFO with supporting documents and recommending solutions.
 
MINIMUM MANDATORY QUALIFICATIONS:
Education:
  • Bachelor’s degree in Business Administration or related field. 
 
Experience:
 
  • Eight (8) years of work experience in third party health care billing and collections and Four (4) years of work experience in a supervisory position in third party health care billing and collections. 
  • Thorough working knowledge of revenue cycle, coding, billing and collection systems. 
  • Practical knowledge of payer-specific rules and regulations, including Medicaid and Medicare 
  • Knowledge of financial reconciliations, managed care programs and ACA legislation. 
 
Mandatory Knowledge, Skills, Abilities and Other Qualifications:
  • Must be a certified Coder.
  • Excellent communication and interpersonal skills including the ability to negotiate and resolve conflicts and build teams.
  • Knowledge of medical terminology.
  • Knowledge of healthcare billing codes (CPT, ICD-10, HCPCS).
  • Knowledge and understanding of state and federal rules and regulations.
  • Ability to operate in high-pressure situations.
  • Excellent organizational skills, planning, and project management abilities.
  • Demonstrated innovative approach to problem resolution.
  • Broad knowledge of modern health care administration practices and principles.
  • Effective analytical ability to develop and analyze options, recommend solutions and solve complex problems and issues.
 
PREFERRED QUALIFICATIONS:
  • Bilingual skills in English and the Keres native language
  • Prior experience working with Indian Health Services (IHS), a Tribe or Tribal organization in Business Office Management. 
  • Working knowledge of NextGen. 
  • Master’s degree in business, healthcare administration, or related field.  
 
WORK ENVIRONMENT: 
The work environment characteristics described here are representative of those an employee encounters while performing the primary functions of this job. Normal office conditions exist, and the noise level in the work environment can vary from low to moderate. This position may be exposed to certain health risks that are inherent when working within a health center facility.
 
PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the primary functions of this job. While performing the duties of this job, the employee may be required to frequently stand, walk, sit, bend, twist, talk and hear. There may be prolonged periods of sitting, keyboarding, reading, as well as driving or riding in transport vehicles. The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include reading, distance, computer, and color vision. Talking and hearing are essential to communicate with patients, vendors and staff.
 
MENTAL DEMANDS:
There are a number of deadlines associated with this position. The employee must also multi-task and interact with a wider variety of people on various and, at times, complicated issues. Works with provider contracts, MOU’s, regulation with government and private entities.
 
OTHER:
 
All employees must uphold all principles of confidentiality and patient care to the fullest extent. This position has access to sensitive information and a breach of these principles will be grounds for immediate termination.
 
 
Disclaimer:  The information on this position description has been designed to indicate the general nature and level of work performance by employees in this position.  It is not designed to contain, or be interpreted as, a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position. Employees will be asked to perform other duties as needed.
Salary Range:  $76,266 to $114,400