Business Office Representative - Washington Staffing : Job Details

The Business Office Representative provides support for the Business Office. Most work at this level involves enrolling for and maintaining continuing health coverage eligibility for clients in the WA Healthplanfinder system. As needed, assist with billing, front desk coverage, and Purchased Referred Care (PRC) duties. This position is regular and full-time.

Duties Include:

For Billing Assistance Include:

• Enter data and post charges in NextGen.
• Re-bill denied and aged claims.
• Register and update patient insurance information and demographics in NextGen.
• Ensure patient data and insurance information is updated on the PRC member roster.
• A/R posting of third-party payments.
• Process, print, and mail forms as needed.
• Participate in on-the-job training and any meetings, workshops, or seminars related to third-party billing issues.
• Monitoring Medicare and Medicaid newsletters and other third-party newsletters is imperative to ensure compliance with billing rules and regulations.
• Understanding and knowledge of how to provide correct insurance information to other department staff are essential.

For Tribal Assister Include:

• Conducts patient outreach and information gathering to determine appropriate insurance services for the patient.
• Conducts interviews to input patient eligibility information into agency systems for those agencies to determine eligibility for medical benefits.
• Explains program requirements and services available. Refers clients to both mandatory and optional services and other agencies as required.
• Detects discrepancies and clarifies data through telephone inquiries, correspondence, and interviews. Recognizes and recomputes incorrect income for medical assistance.
• Works within time frames and deadlines that are dictated by program requirements.

Other Office Duties:

• Provide patient outreach for health coverage.
• Monitor verification and collection of patient demographics and insurance data when checking in at the health clinic and dental front desk.
• Monitor daily medical and dental schedules to ensure Medicaid and enrollment for other applicable health coverage happens at the time of the appointment. This needs to be coordinated with the PRC office to ensure patient information is accurate and regularly updated.
• Provide follow-up on private patient statements and incomplete PRC claims.
• When interacting with other billing offices, provide information and education on the PRC program.
• In coordination with the Billing Coordinator, work with the Tribal Sponsorship Program.
• Reporting is mandatory for tribal employees and contractors with the tribe who perform services to the community in the areas of education, health and human services, law enforcement and members of the clergy.
• Provide front desk coverage as needed.

Remote Work: This position is eligible for alternative scheduling. The schedule must be discussed with and approved by the supervisor and director and may be subject to change depending on the role and department needs.

Other duties as assigned.

Education and Certifications: A High School Diploma or Graduate Equivalent Degree is required. Basic computer skills and the ability to learn Word.