Medical Billing & Claims Denials Specialist

Great Plains Tribal Health; Rapid City (SD); On-site; USD 42,000 - 62,000; Full time

Job summary

Great Plains Tribal Health is seeking a Billing Coordinator to manage third-party insurance billing, review medical information for accurate claims, and collaborate with coders to address denials and recurring issues.

The role requires knowledge of medical billing with HIPAA compliance and strong communication to coordinate with payers, patients, and the coding department while maintaining confidentiality.

Qualifications

• High school diploma or GED and one year of medical billing experience.
• Experience with RPMS and EHR preferred but not required.
• Excellent verbal and written communication skills with the ability to be detail oriented.
• Computer and technical skills (Word, PowerPoint, Excel, Outlook).

Responsibilities

• Prepare, process and submit clean claims to various insurance claims according to payer guidelines and deadlines either electronically or by paper.
• Obtain knowledge on dental billing within the dental billing platform
• Obtain knowledge on pharmacy billing processes
• Obtain knowledge on Honor Every Woman program
• Obtain knowledge on Worker’s Compensation/Attorney claims
• Maintain current knowledge and understanding of each insurance payer’s rules, regulations and deadlines and apply this knowledge in daily duties and assignments
• Recognize and identify errors and communicate these to insurance payers Billing Coordinator II or III.
• Monitor and reconcile delinquent accounts.
• Documented ability to prioritize workload and meet quality and production standards.
• Effectively communicate with clearinghouse and insurance companies regarding claim status, including rejections, denials, corrections and other various issues.
• Communicate with coding department regarding coding-related denials needing correction.
• Provide appropriate third-party account status and any issues to Lead Biller or Business Office Manager.
• Responsible for daily clearinghouse reconciliation of reports and claims.
• Answer questions from patients, clerical staff, tribes, subcontractors and insurance companies.
• Perform various collection actions including contacting by phone, correcting and resubmitting claims to third party payers.
• Participate in CMS, IHS and private insurers’ educational activities as necessary.
• Conduct self in accordance with GPTLHB’s employee manual.
• Maintain strict confidentiality; adhere to all HIPAA guidelines/regulations.
• Perform other related duties as assigned.

Skills

Medical billing

Claims processing

HIPAA compliance

Attention to detail

Communication skills

Customer service

Education

High school diploma or GED

Tools

RPMS

EHR

Microsoft Excel

Microsoft Word

Outlook

Job description

Great Plains Tribal Health is seeking a Billing Coordinator to manage third-party insurance billing, review medical information for accurate claims, and collaborate with coders to address denials and recurring issues.

The role requires knowledge of medical billing with HIPAA compliance and strong communication to coordinate with payers, patients, and the coding department while maintaining confidentiality.