Billing Specialist II Hybrid

Klamath Tribal Health & Family Services; Klamath Falls (OR); Hybrid; USD 42,000 - 73,000; Full time

Benefits offered by this job

Full Benefits

Job summary

Klamath Tribal Health & Family Services is seeking a Billing Specialist II in Oregon to manage patient accounts within a multi-disciplinary Business Office. You will review encounters, apply correct CPT/ICD-10-CM codes, submit claims, post payments, and perform follow-up with payers.

The role requires strong billing knowledge and analytical skills. The hybrid position offers up to 80% remote work after the initial year, with full benefits and opportunities to support diverse payer types in a

Qualifications

• Minimum qualifications include onsite training for the first year; up to 80% remote after training.
• High School Diploma or equivalent required; professional certifications preferred (CPC/CCS/RMC/RHIA/RHIT).
• Experience with medical/dental billing and coding; knowledge of CPT, ICD-10-CM, and CDT is required.

Responsibilities

• Review encounters and ensure correct CPT/ICD coding and medical necessity.
• Submit clean claims to Medicaid/Medicare and private payers; maintain compliance with payer guidelines.
• Post payments, handle refunds, and monitor accounts receivable to optimize cash flow.
• Maintain documentation and perform quality assurance activities across the billing cycle.

Skills

CPT coding

ICD-10-CM

Medical terminology

HIPAA compliance

Education

High School Diploma or Equivalent

CPC/CCS/RMC/RHIA/RHIT certification

Tools

NextGen

Microsoft Excel

Job description

Description

Position description

POSITION

BILLING SPECIALIST II

RESPONSIBLE TO

Business Office Manager

EMPLOYER

Klamath Tribal Health & Family Services

LOCATION

Hybrid – Up to 80% Remote / 20% In Office after initial year of training period

SALARY

Step Range: 12 ($41,892 annually/$20.14 hr.) -31 ($73,459 annually/$35.32 hr.); Full Benefits

CLASSIFICATION

Non-Management, Regular, Full-Time

BACKGROUND

P.L. 101-630 Level

POSITION OBJECTIVE

Klamath Tribal Health & Family Services (KTHFS) is a tribally operated health facility offering direct medical, dental, pharmacy, behavioral health, and non-emergent transportation services to American Indians and Alaska Natives residing within the service delivery area. The Billing Specialist II is responsible for managing patient accounts in a complex, multi-disciplinary Business Office environment. The incumbent shall cross-train with other members of the Business Office and shall participate in all functions of the coding and billing cycle, to include: daily review of encounters, analyzing chart notes and assuring the appropriate service codes are utilized, data entry of encounter forms, posting charges into the computer system, perform claims review, claims submission, timely billing, follow-up and collection of all accounts, payment posting, claims audit and research. The incumbent shall also function as a resource for clinic providers and staff and will assist with coding and billing questions, and quality assurance activities.

MAJOR DUTIES AND RESPONSIBILITIES

• Daily review, analyze, and interpret patient ambulatory EHR and/or paper encounter coding and corresponding chart note documentation and determine that the appropriate diagnostic and procedural codes are used and appropriately reflected in the chart note for code assignment as outlined by the CMS guidelines. Assuring that medical necessity billing guidelines are met.
• Ensure that the appropriate service codes are applied in the billing record that corresponds to the documentation referenced in the chart note or on the encounter forms. Ensure that the appropriate ICD-X, CPT, HCPCS, CDT coding conventions have been used for services provided by all health service types within KTHFS.
• Work with providers, nursing staff, and the business office to clarify documentation in the EHR system if needed. Including correlating anatomical and physiological processes of a diagnosis to assure the most accurate and specified ICD-X code(s) are used. Advise manager and clinicians of deficiencies to support charge capture of all billable services.
• Prepare and submit clean claims (electronic or paper) to primary/secondary insurance carriers including Medicaid, Medicare, (Part A&B), and private insurance companies.
• Maintain compliance with billing regulations: including Medicaid , Medicare (Parts A&B, DME), and private Insurance Carriers.
• Payment post insurance checks or EFTs, which includes: verifying the checks or EFTs that have been receipted in the Master Check’s & EFT’s Microsoft spreadsheet, batching the checks or EFTs into NextGen and then accurately posting the payments.
• Process refunds for any overpayments made to KTHFS. Monitor claims payment and promptly request POs for refunds to insurance companies, or perform electronic claim adjustments per payer requirements, for any overpayments made on claims. The refund will also be processed to reflect the refunded claim in NextGen.
• Process No-Pay EOBs by applying an adjustment and creating billing and claim follow-up notes. This includes the appeal of insurance claims that have been wrongfully paid or denied, contacting insurance companies by phone to obtain information concerning extent of benefits and/or settle unpaid claims and providing any additional information requested by insurance companies for the processing of submitted claims.
• Record in NextGen system all claims related phone calls, correspondence, and activities related to each patient account.
• Maintain current filing system for encounters, POs, etc., process daily incoming mail and correspondence for review, completion, and filing.
• Communicate regularly with Patient Registration and record patient benefit effective/term date(s) into the practice management system as needed.
• Create electronic batches to submit to the clearinghouse and reconcile with the submitted claims tracking spreadsheet including follow up on electronic claims receipt by payer. Correct any claims before archiving the file in the clearinghouse.
• Work outstanding A/R by reviewing, rebilling, and adjusting accounts to ensure accurate and thorough billing of claims, by running reports and working on claims. Track and monitor claims processing, ensure timely follow-up for the payment of bills; Identify, and resolve all outstanding/pending claims.
• Monitor the Business Office outlook inbox regularly and back bill any claims and/or adjust claims where applicable.
• Run specific reports as identified below:
  • To be run and worked weekly - Pending Charges Report, Unbilled and Rebilled Encounters, Paper Claims printed, Clearinghouse Reports (claims denied, outstanding claims, claims removed, claims rejected)
  • Biweekly reports - Kept Appointments with No Encounters report, Aging Reports, and maintaining up to date reports making sure all old billing is addressed.
• Establish and maintain an effective working relationship with public and private payers; identify potential problems that could cause interruptions to cash flow.
• Participate in yearly chart audit activities for quality assurance purposes; document results in report format, as needed, for review by the Chief Medical Officer and the Chief Quality Officer.
• Attend coding seminars, meetings, or other training opportunities to keep abreast of changes in the profession.
• Like all employees of the Klamath Tribes, the incumbent will be called upon to accomplish other tasks that may not be directly related to this position, but are integral to the Klamath Tribes’ broader functions, including but not limited to, assisting during Tribal sponsored cultural, traditional, or community events that enable the successful operation of programs and practices of The Klamath Tribes as aligned with The Klamath Tribes’ Mission Statement. Some of these tasks may be scheduled outside of regular work hours, if necessary.

SUPERVISORY CONTROLS

Work under the supervision of the Business Office Manager, who provides general instructions. Work is assigned in terms of functional/organizational objectives. The manager assists with unusual situations that do not have clear precedents.

Employees must be able to work with minimal supervision, using initiative and judgement in setting priorities to meet the demands of the workload. Work is performed within the purview of laws, and regulations. The manager will review work regularly for quality and compliance with established policies and procedures and payer guidelines.

KNOWLEDGE, SKILLS, ABILITIES

Technical knowledge, skill, and understanding of the American Medical Association developed CPT coding system to acquire, interpret, and resolve problems based on information derived from system monitoring reports to be carried over to the required billing forms.

Technical knowledge, skill, and understanding of the concepts of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-X-CM) for classification of diseases and/or procedures.

Knowledge and understanding of CDT dental coding system.

Basic knowledge and understanding of HCPCS coding.

Knowledge of mental health and alcohol and drug coding and billing is desirable.

Ability to work with minimal supervision, using initiative and judgment in setting priorities to meet the demands of the workload while adhering to the insurance rules and regulations that relate to coding and billing.

The knowledge of and/or the ability to learn the billing guidelines as they pertain to FQHC/Tribal Health Clinics.

Knowledge of established procedures required claim forms (both paper and electronic) associated with the various health insurance programs.

In-depth knowledge of Medicaid (OARs, Rulebooks).

In-depth knowledge of Medicare Part A & B billing regulations.

Knowledge of medical terminology.

Knowledge of claims review, account auditing, and quality assurance.

The ability of tracking, handling, and completing multiple projects.

Ability to communicate well (both orally and in writing) and work effectively with other employees, managers, and administrators. This person should be able to express themselves in a clear and concise manner for the purposes of correspondence, reports and instructions, as well as for obtaining and conveying information to ensure a cooperative working relationship with all staff.

Willingness to maintain expertise to keep current with changes in procedure and diagnosis coding and third-party payer reimbursement policies through continuing education.

Above average ability to work with numbers and set standards to assure proper payment and adjustments posting.

Must be dependable, thorough, accurate, well-organized and detail oriented.

Ability to maintain strict confidentiality of medical records and adhere to the standards for health record-keeping, HIPAA and Privacy Act requirements.

Conduct self in accordance with KTH&FS Employee Policy & Procedure Manual.

QUALIFICATIONS, EXPERIENCE, EDUCATION

Minimum Qualifications: Failure to comply with minimum position requirements may result in termination of employment.

• REQUIRED Onsite training/working for the first year upon hire may be required. Up to 80% of remote work after training requirements are completed subject to business needs and management approval.
• REQUIRED to possess a High School Diploma or Equivalent. (Must submit a copy of diploma or transcripts with application.)
• REQUIRED Must have one of the following certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Medical Coder (RMC), RHIA, RHIT or an associate’s degree in medical office systems or health information management.
• REQUIRED One (1) year of medical and/or dental billing and coding experience. Experience must be reflected in application; or submit copy of coder certification with application.
• REQUIRED Demonstrated proficiency in technical knowledge of medical terminology, anatomy and physiology, and CPT and ICD-10-CM coding systems
• REQUIRED to have Computer and/or word processor experience.
• REQUIRED to submit to a background and character investigation, as per Tribal policy. Following hire must immediately report to Human Resource any citation, arrest, conviction for a misdemeanor or felony crime.
• REQUIRED to submit to annual TB skin testing and adhere to KTHFS staff immunization policy in accordance with the Centers for Disease Control immunization recommendations for healthcare workers.
• REQUIRED to accept the responsibility of a mandatory reporter in accordance with the Klamath Tribes Juvenile Ordinance Title 2, Chapter 15.64 and General Resolution #2005 003, all Tribal staff are considered mandatory reporters.

Preferred Qualifications:

• AAPC coder certified, or AHIMA coder certified.
• Experience with NextGen or other electronic health record systems is preferred.

Indian Preference:

• Indian Preference will apply as per policy. Must submit documentation with application to qualify for Indian Preference.

ACKNOWLEDGEMENT

This job description is intended to provide an overview of the requirements of the position. It is not necessarily inclusive, and the job may require other essential and/or non-essential functions, tasks, duties, or responsibilities not listed herein. Management reserves the sole right to add, modify, or exclude any essential or non-essential requirement at any time with or without notice. Nothing in this job description, or by the completion of any job requirement by the employee, is intended to create a contract of employment of any type.