Employment Opportunities

This position is located at the Little Axe Clinic within the AST Purchased Referred Care Services Division. This position serves as a liaison between Absentee Shawnee Tribal Health (ASTH), Absentee Shawnee Tribal (AST) Members, and third-party healthcare providers to whom patients have been referred. The position works closely with the Referral Specialist regarding approved Coordination of Benefits (COB) submissions and processes incoming CMS-1500 professional claims and UB hospital claims for payment on behalf of AST Members. Responsibilities include reviewing and processing claims, entering required information into the Plexis database, and generating Purchase Requests for payment. The position also verifies insurance coverage and ensures that current AST enrollment and Certificate of Degree of Indian Blood (CDIB) documentation are present in the Member’s chart.

• Perform clerical, processing patient medical claims, retrieval of records and inputting billing data in a data base. 
• Manage eligible Tribal members’ profiles, including intakes, updates, consents and other important information.
• Provide information in person or by telephone regarding services benefits available under the Absentee Shawnee Tribe’s PRC Health Programs guidelines.
• Respond to PRC inquiries and requests for PRC assistance. Such responses are through telephone, correspondence, email and personal visits with other billing entities. 
• Develop and maintain a positive working relationship and supports the overall team effort of the Absentee Shawnee Tribal Health program providers within the clinics, physicians, community outreach programs, third party resources, community health care nurses, home health care nurses, diabetes initiative, behavioral health, business office, health board and Case Manager Review Committee.
• Enter, update, and verify all alternate resource data necessary for patient and third -party payers; verify insurance coverage; requesting updates by contacting clinic PBA for insurance eligibility.
• Perform routine clerical duties including processing incoming and outgoing mail, logging all incoming calls, copying all necessary documents, filing, and maintains mailing lists.
• Manage Tribal members’ profiles, including updates, consents and other important information
• Maintain documents for filing of vendor invoices and mailing denials. 
• Provide information in person or by telephone regarding services available under the Absentee Shawnee Tribe’s Health Programs.
• Respond to PRC inquiries and requests for PRC assistance.  Such responses are through telephone, correspondence, email and personal visits with AST Members.
• Develop and maintain a positive working relationship and supports the overall team effort of the Absentee Shawnee Tribal Health Program providers including clinics, physicians, behavioral health, billing office.
• Enter client data into the appropriate database; maintains accurate files, and organizes data.
• Maintain strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Attend health orientation, HIPAA training, safety training and other health system training needed to be competent in their position.
• Perform other duties assigned.

• High School graduate or GED. 
• 3 or more years’ experience in a medical or business office setting.
• Experience as a medical claims’ processor preferred.
• Understanding insurance explanation of benefits (EOB) from primary insurance.
• Completion of a program or training in Medical Office Billing/Coding or a related field preferred.
• Experience with electronic health record (EHR) software preferred.

• Must be computer literate.
• Incumbent must possess the ability to interact with a wide variety of individuals and handle several complex situations simultaneously.
• Impeccable communication and negotiation skills, written and verbal, and excellent computer skills.
• Must be able to provide quality customer service. 
• Must be able to apply critical thinking through the ever changing work environment. 
• Knowledge of software to access and interpret patient data.
• Ability to communicate with patients, families, caregivers and other healthcare professions.
• Ability to be culturally sensitive to Native Americans.
• Good organizational and assessment skills.
• Must be self-motivated. 
• Must be able to prioritize work tasks and be creative with projects.
• Must be able to perform duties with a minimum of supervision.
• Must be able to function as a team member.
• Must be able to be a dependable team member of the clinic setting and be ready to start work on time.
• Must be able to be sedentary for long periods of time, will require a majority of sitting time.
• Must be able to work in an office setting with public interaction and exposure to potential illnesses.
• Must possess a valid Oklahoma Driver’s license.
• Must be able to pass a background check and drug screen.

• Must be able to sit, stand, stoop, bend or kneel for long periods of time.
• Sitting or standing or walking for long period of time; occasional bending, squatting, kneeling, stooping; good finger dexterity and feeling; frequent repetitive motions; talking hearing and visual acuity.
• Frequent lifting (up to 15 lbs)
• Occasional lifting (up to 30 lbs)

The Absentee Shawnee Tribe of Oklahoma (AST) is committed to Equal Employment without regard to race, religion, color, gender, national origin, age, disability, or sexual orientation. However, in accordance with the Indian Preference Act (Title 25 U.S. Code 472 and 473) preference in filling vacancies are given to qualified Indian candidates. AST will make reasonable accommodations in compliance with the Americans with Disabilities Act of 1990 and its amendments.

Native American Preference/EEO/Drug Free/Smoke Free Workplace