Biller/Coder Credentialing Specialist

SUMMARY

The Medical Biller/Coder works under the supervision of the Budget Manager and Data Analyst and is responsible for timely submission of clinic super bills, dental billing, and reconciliation(posting) of all payments received and follow up for all account's receivables for all direct services, detecting any problems in the billing system and correct them accordingly. This position also serves as the Credentialing specialist for Providers and Billable insurances. Will step-in as a Personal Health Record (PHR) Liaison and work in collaboration with clinical staff, Purchased Referred Care staff, and clerical staff, including filling in to enter PCC Data in an efficient and timely manner as needed, oversees compliance with applicable standards, ICD, CPT, E/M, and HCPC coding for all direct services.

MINIMUM QUALIFICATIONS

• High School diploma or GED.
• Must have knowledge of CPT / ICD- coding and understand medical terminology.
• A minimum of one to three years of experience in a medical office setting.
• A working knowledge of provider and insurance credentialing.
• Must work towards medical coder certification within 1 year of employment, or as determined by direct supervisor.
• Thorough knowledge of medical terminology, anatomy, physiology, disease processes, medical record science, computer applications in medical records and current dynamics in the health care industry.
• Up to date with health information technologies and applications
• Must have a valid unrestricted driver license and be insurable by the GTB insurance carrier.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Performs the full range of medical coding and applies coding knowledge to a wide range of areas.
• Consults with providers and others for clarification and additional documentation to resolve conflicting or ambiguous data.
• Responsible for driving process improvement initiatives related to front end revenue cycle functions in collaboration with billing company, clinic staff, Supervisor and Health Administrator
• Checks eligibility and benefits verification for treatments, hospitalizations, and procedures as necessary to resolve claims.
• Reviews patient bills for accuracy and completeness and obtaining missing information.
• Prepares, reviews, and transmits claims using billing software, including electronic and paper claim processing.
• Follows up on unpaid claims within standard billing cycle timeframe.
• Calls insurance companies regarding discrepancy in payments, researches them, and works to resolves them as necessary.
• Assists in identifying primary, secondary, or tertiary insurances.
• Reviews accounts for insurance of patient follow-up.
• Research and appeals denied claims.
• Credentials providers under the GTB Clinic NPI, and billable insurances.
• Answers all patient or insurance telephone inquiries pertaining to assigned accounts.
• Reviews provider notes to ensure that all services rendered are billed in compliance with applicable standards.
• Reviews all patient visits to ensure that all services rendered will be billed properly by the clinic.
• Enter all diagnosis codes and billing codes in RPMS for billing preparation.
• Posts reimbursement from 3rd party payers and forwards any payment to accounting.
• Reviews Explanation of Benefits (EOBs) from insurance plans against charges and determines whether payment/allowance is correct.
• Assists in monthly closeout for billing including review of payments and write-offs.
• Maintains proper files / records for completed patient visits and ensures records are complete, accurately documented, and systematically organized.
• Coordinate with I.H.S and other agencies to ensure billing standards are met.
• Attends workshops and seminars for professional development for billing, updates on coding/credentialing, and PHI integrity.
• Maintains all correspondence and documentation of 3rd party payments.
• Provides a monthly report to direct supervisor as specified.

OTHER SKILLS AND ABILITIES

• Must have excellent verbal and written communication skills.
• Must have excellent interpersonal skills with demonstrated patience, tact, and respect.
• Must have exceptional detail and follow-up skills.
• Must have excellent customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members of diverse ages.
• Problem-solving skills to research and resolve discrepancies, denials, appeals and collections.
• Ability to work well in a team environment. Being able to triage priorities, delegate tasks if needed, and handle conflict in a reasonable fashion.
• Knowledge of accounting and bookkeeping procedures.
• Knowledge of medical terminology that may likely be encountered in medical claims.
• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid and other payer requirements and systems.
• Familiarity with CPT and ICD-10 Coding.
• Must have proven proficiency in computers, including Microsoft Windows Operating System and Microsoft Office Suite and the Resource Patient Management System (RPMS) or similar billing software.
• Maintain patient confidentiality as per Health Insurance Portability and Accountability Act (HIPAA) of 1996 and complete HIPAA compliance training.
• Ability to multitask.

EDUCATION and/or EXPERIENCE

• High School diploma or GED certificate.
• Must have knowledge of CPT / ICD- coding.
• A minimum of one to three years of experience in a medical office setting preferred.
• Understanding of medical terminology.
• Basic PRC knowledge preferred.
• Must work towards coder certification within 1 year of employment, or as determined by direct supervisor.

SUPERVISORY RESPONSIBILITIES

None

EQUIPMENT TO BE USED

General office equipment such as computers, calculators, modems, copiers, fax machines, telephone systems, etc.

TYPICAL PHYSICAL DEMANDS

Work requires sitting, lifting, reaching, walking, and lifting heavy objects, such as a case of paper or several books at once. Need to be in good physical and mental health. Assisting patients may be required from time to time. Also requires manual dexterity to operate office equipment, keyboarding, copiers, etc.

TYPICAL MENTAL DEMANDS

The employee uses judgment in identifying and selecting most appropriate procedures to use, or in determining which of several established alternatives to use. Some deadlines are involved, so there is time pressure on occasion.

WORKING CONDITIONS

A good deal of work is performed in an office environment, but it is important to realize that some of the work is on the floor and in the other offices.

COMMENTS

Native American Preference will apply. Must be willing and able to pass a background investigation and a drug and alcohol urinalysis as a condition of employment. Adherence to strict company policy regarding confidentiality is a must.

The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Management retains the right to add or to change the duties of the position at any time through an approved motion by Tribal Council. * Any qualifications to be considered as equivalents in lieu of stated minimums require prior approval of the Director of Human Resources.

Current Openings for Biller/Coder Credentialing Specialist Jobs at Grand Traverse Band of Ottawa and Chippewa Indians