Overview
This role involves preparing and processing eligible billing claims for travel services under normal supervision. The position requires reviewing and adjusting accounts to ensure accurate and thorough processing of claims.
Responsibilities
- Ensure high-quality, timely completion of work with accurate data entry and efficient processes.
- Maintain positive working relationships with internal and external patients/clients.
- Set up and manage all aspects of billing systems according to Medicare, Medicaid, and Private Insurance requirements.
- Process and prepare business and government forms.
- Manage all electronic claims entry and processing.
- Investigate denied claims and edit for re-submission.
- Perform quality assurance testing on all EMR programs to ensure accurate processing and data compilation for required payers.
- Assure timely billing and collections, maintaining a collection rate of less than 30% with accounts receivable of 60 days or greater.
- Research billing and coding requirements for new services as directed.
- Maintain strong working knowledge of coding, including changes in coding and modifiers.
- Consult with providers to resolve or clarify codes and diagnoses with conflicting, missing, or unclear information.
- Create and edit templates and codes in the EMR system as directed by providers.
- Monitor and order CPT/ICD-10 coding books for clinic staff.
- Maintain Electronic Data Interchange (EDI) systems for services.
- Review, prepare, and submit claims to all third-party payers; identify appropriateness of billable charges and determine primary payer when multiple payers are listed.
- Provide documentation and reports with claims when necessary.
- Identify every billable expense and increase revenue efficiently by preparing and submitting insurance claims and reviewing accounts for accurate and timely payments.
- Prepare monthly aging reports.
- Maintain strong knowledge of referral and claim processing software, master files, and interface conversion tables.
- Perform other duties as assigned.
Knowledge and Skills
- Knowledge of electronic medical record (EMR) systems.
- Knowledge of ICD-10 and CPT coding.
- Knowledge of medical insurance processes.
- Knowledge of alternative health resources.
- Knowledge of customer service concepts and practices.
- Knowledge of basic medical terminology and clinic systems.
- Knowledge of the Privacy Act of 1974 and HIPAA Privacy Rule Act of 1966.
- Knowledge of state, federal, and tribal health care programs.
- Knowledge of state, federal, and public/private insurance, including Medicaid and Medicare.
- Ability to work independently.
- Proficiency in grammar, spelling, sentence structure, and effective business letter writing.
- Skill in operating office equipment such as copiers and fax machines.
- Ability to interpret state, federal, and public/private insurance financing.
- Ability to establish and maintain cooperative working relationships.
- Proficiency in operating a personal computer using various software applications.
Minimum Qualifications
- Associate’s Degree in Business, Finance, Accounting, or a related field. Alternatively, progressively responsible accounting technician, medical billing, or related work experience may be substituted on a year-for-year basis for college education.
Experience
- Non-supervisory: Four (4) years of accounting, billing, insurance, medical claims, care office, or related experience. An equivalent combination of relevant education and/or training may be substituted for experience.
Compensation and Benefits
- Medical insurance provided through the Federal Employee Health Benefits Program with over 20 plans and tiers.
- Cost-share dental and vision insurance.
- Discounted pet insurance.
- Retirement contributions with pre-tax or Roth options into a 403(b) plan.
- 401(a) retirement plan with matching contributions up to 5% after one year of employment and potential annual discretionary contributions up to 3%.
- Paid time off starting immediately, earning up to 6 hours per pay period, with accruals increasing based on years of service.
- Eleven paid holidays.
- Paid parental leave or miscarriage/stillbirth leave eligibility after six months of employment.
- Basic short/long term disability premiums, accidental death and dismemberment (AD&D) insurance, and basic life insurance covered 100% by the employer, with additional voluntary coverage options.
- Flexible spending accounts for healthcare and dependent care.
- Ancillary cash benefits for accident, hospital indemnity, and critical illness.
- On-site child care facility with expert-designed classrooms for early child development and preschool.
- Employee assistance program offering support for grief, financial counseling, mental/emotional health, and discounted legal advice.
- On-site training courses and professional development opportunities.
- License and certification reimbursements and occupational insurance for medical staff.
- Emergency travel assistance.
- Education assistance or education leave eligibility.
- Discount programs for travel, gym memberships, amusement parks, and more.
Location
This position serves Alaska Native and American Indian populations in Alaska and is part of a large tribal health organization serving over 171,000 people across the state.