Medical Billing and Coding Specialist

Nisqually Indian Tribe; Olympia (CA); On-site; USD 34,000 - 46,000; Full time

Job summary

Nisqually Indian Tribe is seeking a skilled Medical Billing Specialist to handle patient billing, claims processing and data integrity within a tribal health setting.

You will verify invoices, follow up on claims, and ensure accurate coding using ICD-10-CM/CPT. Maintain confidentiality and comply with tribal, state, and federal privacy policies while supporting timely reimbursements.

Qualifications

• High school diploma or GED and one year clerical experience in health care or basic accounting
• Medical Billing Specialist Certification required
• Knowledge of HIPAA and patient privacy regulations

Responsibilities

• Process insurance payer statements and post transactions
• Follow up on submitted claims and resubmit as needed
• Receive and receipt third party reimbursements and reconcile payments
• Balance daily batches and generate income and statistical reports
• Maintain patient demographic and billing data with strict confidentiality
• Enter patient information into Greenway/Integrity and apply correct CPT/ICD-10 coding
• Print PCC forms, track billing and scheduling information

Skills

Privacy laws knowledge

Data entry accuracy

Attention to detail

Billing procedures

Communication skills

Education

High school diploma or GED

Medical Billing Specialist Certification

Tools

Greenway/Integrity

Job description

Please note: NSORNA Nisqually's Sex Offender Registration and Notification Act requires all individuals who have ever been convicted of a sex offense to register with our Public Safety Department. This is true whether or not you have to register with another jurisdiction.

This position has regular contact with or control over Indian Children and Vulnerable Adults. In compliance with Federal Law, this position will not be filled by an applicant with any felonious offense or any of two or more misdemeanor offenses under Federal, State, or Tribal law involving crimes of violence; sexual assault, molestation, exploitation, contact, or prostitution; crimes against persons; or offenses committed against children.

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 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, 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 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 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.