Principal Medical Claims Specialist

at  Alaska Native Tribal Health Consortium

The Alaska Native Tribal Health Consortium is a non-profit Tribal health organization designed to meet the unique health needs of Alaska Native and American Indian people living in Alaska. In partnership with the more than 171,000 Alaska Native and American Indian people that we serve and the Tribal health organizations of the Alaska Tribal Health System, ANTHC provides world-class health services, which include comprehensive medical services at the Alaska Native Medical Center, wellness programs, disease research and prevention, rural provider training and rural water and sanitation systems construction.
ANTHC is the largest, most comprehensive Tribal health organization in the United States, and Alaska’s second-largest health employer with more than 3,100 employees offering an array of health services to people around the nation’s largest state.
Our vision: Alaska Native people are the healthiest people in the world.

ANTHC offers a competitive and comprehensive Benefits Package for all Benefit Eligible Employees, which includes:

• Medical Insurance provided through the Federal Employee Health Benefits Program as a Tribal Employee, with over 20 plans and tiers.
• Cost-Share Dental and Vision Insurances
• Discounted Pet Insurance
• Retirement Contributions with Pre-Tax or Roth options into a 403(b).
• Retirement Match and Discretionary. ANTHC matches up to 5%, with a 3% discretionary contribution after one year of employment into a 401(a).
• Paid Time Off starts immediately, earning up to 6 hours per pay period, with paid time off accruals increasing based on years of service.
• Twelve Paid Holidays
• Paid Parental Leave or miscarriage/stillbirth eligibility after six months of employment
• Basic Short/Long Term Disability premiums, Accidental Death and Dismemberment (AD&D) Insurance, and Basic Life Insurance are covered 100% by ANTHC, with additional options for Short-Term Disability Buy-Up Coverage and Voluntary Life for yourself and your family members.
• Flexible Spending Accounts for Healthcare and Dependent Care.
• Ancillary Cash Benefits for accident, hospital indemnity, and critical illness.
• On-Site Child Care Facility with expert-designed classrooms for early child development and preschool.
• Employee Assistance Program with support for grief, financial counseling, mental/emotional health, and discounted legal advice.
• Tuition Discounts for you and your eligible dependents at Alaska Pacific University.
• On-Site Training Courses and Professional Development Opportunities.
• License and certification reimbursements and occupational insurance for medical staff.
• Gym Access to Alaska Pacific University includes a salt water pool, rock climbing, workout gym, and steep discounts for outdoor equipment rentals.
• Emergency Travel Assistance
• Education Assistance or Education leave eligibility

• Discount program for travel, gym memberships, amusement parks, and more.

  or contact Recruitment directly at HRRecruiting@anthc.org.
  Alaska Native Tribal Health Consortium has a hiring preference for qualified Alaska Native and American Indian applicants pursuant to P.L. 93-638 Indian Self Determination Act.
  Summary:
  Under general supervision, assists in the preparation and submission of catastrophic health emergency (CHEF) requests; review and track reimbursement request and offsets to ensure accurate adjustment of claims; monitors and ensures timely payment of pended FI claims. Develop, test, and training of new referral and/or claims procedures.
  Responsibilities:

KNOWLEDGE AND SKILLS

· Knowledge of medical billing and accounting procedures and applications.
· Knowledge of claims review, analysis and quality assurance.
· Knowledge of commercial insurance and government reimbursement programs.
· Knowledge of basic medical terminology and clinic processes.
· Knowledge of reception, typing, computer operations, and filing.
· Skill in operating a personal computer using a variety of software including medical billing applications.
· Skill in tracking and accomplishing multiple tasks and assignments.
· Skill in establishing and maintaining cooperative working relationships with other employees.
· Skill in conducting successful telephone consultations and operating a multi-line office phone system.
Other information:

MINIMUM EDUCATION QUALIFICATION

An Associate’s Degree in business, finance or related discipline. Progressively responsible related work experience may be substituted on a year-for-year basis for college education.

MINIMUM EXPERIENCE QUALIFICATION

Non-supervisory - Seven (7) years of experience working in a medical office performing medical billing processes. An equivalent combination of relevant education and/or training may be substituted for experience.

D evelops and tests new PRC procedures. Assists in implementation of new office processes.
Determines eligibility of catastrophic health emergency fund claims based on Federal guidelines and operating procedures. Submits requests to the Alaska Area Office for reimbursement and/or recovery. Tracks, monitors, and reports on CHEF year-to-date activity. Processes, researches and corrects accounts to verify CHEF related services paid internally with ANTHC Finance/Accounts Payable. Ensures correct and prompt resolution of FI claim edits with claims pended with the Fiscal Intermediary; maintaining strong knowledge of system software, master files and interface conversion tables. Reviews and tracks accounts where reimbursements were requested from the Provider through the Fiscal Intermediary. Participates in provider reimbursement requests and offsets; ensures accounts are updated to reflect reimbursements and/or offsets. Verifies all identified insurance carriers for eligibility; confirms carrier policy where additional review is needed as part of the referral pre-authorization and claims payment process. Posts payments and adjustments in purchase order databases for claims not submitted to the F.I. (credit and payments or ANTHC checks). Creates, organizes, corrects, updates and maintains accounts on data spreadsheets. Assists in decision making processes regarding data. Trains and mentors staff. Assists in monitoring of staff in training and beyond. Takes lead on special projects as assigned to assure completion. Assists in distributing workload among coworkers; provides assistance to coworkers; monitors and reviews coworkers’ progress. Acts as a backup to cover multiple positions in office. Provides assistance to patients, providers, and other external parties. Performs other duties as assigned.