JOB TITLE:

Medical Billing & Coding Specialist

DEPARTMENT:

Nisqually Health & Wellness Center

SUPERVISOR:

Third Party Billing Revenue Cycle Manager

SALARY:

29.63 DOE

JOB SUMMARY:

Performs a variety of complex clerical and accounting functions for patient billing, including verification of invoice information and resolution of a variety of problems with patients or private insurance carriers. Follows up on submitted claims and patient billing; resubmits claims or resolves billing problems.

JOB RESPONSIBILITIES:

  • Processes insurance payer statements, keys data, posts transactions, and verifies accuracy of input to reports generated.
  • Follows up on submitted claims; monitors unpaid claims, initiates tracers; resubmits claims as necessary.
  • May receive and receipt third party reimbursements; posts and reconciles payments.
  • Balances daily batches and reports; prepares income reports including month end reports and statistics; distributes reports.
  • Maintains patient demographic information and data collection systems to ensure patient eligibility and third party coverage; reviews information for accuracy and make necessary changes.
  • Maintains files containing patient health information according to Tribal Policy; and ensures strict confidentiality of files containing patient health information and financial records.
  • Reviews all client encounter forms and super bills from health care providers and other health program staff for services as assigned for accuracy and completeness.
  • Enters patient information into Greenway/Integrity; determines proper CPT, ICD10 or other appropriate coding; then codes and enters data for visits, sessions or other billable program services.
  • Batches and enters Patient Component Care (PCC) forms and makes appropriate adjustments; and prints claim forms for the PCC’s on a daily basis.
  • Tracks billing and scheduling information as necessary.
  • Knowledge of tribal, state and federal patient privacy of information legislation.
  • Maintain patient and billing records according to Tribal policy.
  • Demonstrated ability to read and understand provider’s handwritten narratives using detailed medical terminology asking for clarification when needed to correctly enter into the computer.
  • Working knowledge of Greenway/Integrity.
  • Knowledge of ICD 10 -CM/CPT coding system in order to correctly enter data including the ability to verify data input and correct errors.
  • Knowledge of billing procedures, regulations and standards and ability to apply them to Medicare, Medicaid and/or other private insurance carriers.
  • Knowledge of the organization and purpose of the documentation used to bill and collect.
  • Ability to gather data, compile information, and prepare reports.
  • Maintain courteous and effective relationship with patient/clients and the general public; and work with a diverse group of people.
  • Ability to maintain confidentiality of patient records according to tribal and federal patient privacy of information legislation.
  • Ability to maintain quality, safety and infection control standards.
  • Ability to meet production standards.
  • Ability to communicate effectively both orally and in writing.
  • Experience working with Native American populations desired.

MINIMUM REQUIREMENTS:

  • Must be able to successfully pass a criminal history background check.
  • High school diploma or GED and one year clerical experience working in health care or in a position that requires an understanding of basic accounting principles.
  • Must have a Medical Billing Specialist Certification.
  • Valid WA State Driver’s License and must be insurable under the Tribe’s automobile insurance.

PREFERRED REQUIREMENTS:

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