Medical Billing and Coding Specialist

NATURE OF WORK: 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.

DUTIES AND RESPONSIBILITIES: Processes patient 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 cash items and third party reimbursements; posts and reconciles payments to patient ledgers. 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 the RPMS Computer Database; determines proper CPT, ICD9 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, SKILLS AND ABILITIES: 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 RPMS Computer Database systems. Knowledge of ICD 9 -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 QUALIFICATIONS: 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. Must be able to successfully pass a criminal history background check.