PLEASE NOTE - This position may require temporarily relocation to other TONHC Facilities: Sells Hospital, Santa Rosa Health Center, San Simon Health Center, Casa Grande, and San Xavier Health Center.

Position Summary:

The incumbent is responsible for posting third-party (Medicare, Medicaid, and Private Insurance) payments and adjustments to the accounts receivable ledger (RPMS) in the Patient Accounts Section.

Scope of Work:

The position is located at the TONHC Hospital and Clinics. The incumbent works under the general supervision of the Business Office Manager or designee.

Essential Duties and Responsibilities: (Depending on the area of assignment, an incumbent may not be required to perform some of the duties listed below):

• Maintains accounts by reviewing documents to verify accounting data and entering data into the system.
• Reconcile accounts, compare account balances with related data to assure agreement, reviewing records and source documents to identify the sources of discrepancies.
• Prepares reports reflecting the examination made, discrepancies noted, and the corrective entries required adjusting accounts.
• Examine for accuracy of claims and other requests for payment for (1) services provided by TONHC; (2) reimbursement of expenditures made by beneficiaries and non-beneficiaries for such purposes as medical care and treatment.
• Maintains the automated accounts receivable ledger associated with third-party payer claims; responsible for associated records and documentation.
• Reviews and reconciles all third-party documents for correct data on all third-party vouchers for accurate claim numbers.
• Prepares weekly, monthly, quarterly and annual reconciliation and recapitulation of third-party billing to assure that collections, billed data, and the computerized and manual reports are in balance.
• Reviews and examines various bill types of patient care to third-party payers and performs third-party collection posting to the automated accounts receivable program.
• Receives and reviews all Explanations of Benefits and remittances from third-party payers. Identifies and records proper claim numbers on each remittance and posts them to the appropriate account.
• Responsible for posting all contractual/adjustments related to, and in conjunction with, posting payments per hospital policy and procedures. Monitors account balances, reviews postings to ensure accuracy, and recommends appropriate corrective action.
• Audits all documents received for completeness and accuracy; analyzes and selects guide to determine whether payments are full or partial per hospital policy and procedures; whether they are timely; and whether remittances are advances, installments, or supplements.
• Maintains current documentation and guidelines on reimbursement activities to appropriate files, binders, etc., and ensures preparation and distribution of copies to all applicable disciplines.
• Safeguard the alternate health insurance claims' resource program contents as privileged communication and disclosure of information only within TONHC policy limits.
• Completes special projects within the required timeframe to ensure compatibility of project specifications.
• Verifies the accuracy of payment history for the period involved and determines the extent of underpayment or overpayment.
• Responsible for assisting in the timely resolution of unidentified cash received by the hospital according to hospital policy and procedures.
• Maintains confidentiality when handling financial records or documents.
• Performs other job-related duties as assigned and contributes to a team effort.

Knowledge, Skills, and Abilities:

• Knowledge of the Tohono O'odham culture, customs, and traditions.
• Knowledge of applicable federal, state, tribal laws, regulations, and requirements.
• Knowledge of TONHC Internal Controls policies and standards for accuracy and timely posting.
• Knowledge of total program operation and the priorities and goals of the Alternate Resources program.
• Knowledge of current changes in policy regulations on eligibility.
• Knowledge of third-party payer reimbursement logic and the total accou