Billing Specialist II Hybrid

Klamath Tribal Health and Family Services•Klamath Falls, OR

2d•Hybrid

About The Position

Klamath Tribal Health & Family Services (KTHFS) is a tribally operated health facility providing medical, dental, pharmacy, behavioral health, and non-emergent transportation services to American Indians and Alaska Natives within its service area. The Billing Specialist II manages patient accounts in a complex, multidisciplinary Business Office and participates in the full coding and billing cycle, including encounter review, code selection, charge entry, claims review and submission, payment posting, follow-up, collections, claims audits, and research. The specialist also supports clinic providers and staff with coding and billing questions and quality assurance activities. The position works under the general supervision of the Business Office Manager and requires initiative and judgment to prioritize work with minimal supervision. Work is reviewed regularly for quality and compliance with policies, procedures, laws, regulations, and payer guidelines. Onsite training and work may be required for the first year; after training, up to 80% remote work may be possible depending on business needs and management approval. The role may also involve assisting with Tribal cultural, traditional, or community events, including tasks scheduled outside regular work hours if necessary.

Requirements

High school diploma or equivalent; a copy of the diploma or transcripts must be submitted with the application.
One of the following: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Medical Coder (RMC), RHIA, RHIT, or an associate degree in medical office systems or health information management.
At least one year of medical and/or dental billing and coding experience, reflected in the application or supported by a copy of coder certification.
Demonstrated technical knowledge of medical terminology, anatomy and physiology, and CPT and ICD-10-CM coding systems.
Computer and/or word processor experience.
Ability to work with minimal supervision and use initiative and judgment to prioritize workload while following insurance coding and billing rules.
Ability to learn and apply billing guidelines for FQHC and Tribal Health Clinics.
Knowledge of required claim forms and procedures for paper and electronic submissions across health insurance programs.
In-depth knowledge of Medicaid rules and regulations and Medicare Part A and B billing regulations.
Knowledge of CDT coding, basic HCPCS coding, claims review, account auditing, and quality assurance.
Ability to track, handle, and complete multiple projects; communicate clearly orally and in writing; and work effectively with employees, managers, and administrators.
Ability and willingness to maintain expertise through continuing education on coding changes and third-party payer reimbursement policies.
Above-average ability with numbers and payment and adjustment posting.
Dependability, thoroughness, accuracy, organization, and attention to detail.
Ability to maintain medical-record confidentiality and comply with health-record standards, HIPAA, and Privacy Act requirements.
Must comply with the KTH&FS Employee Policy & Procedure Manual.
Must submit to a background and character investigation under Tribal policy and report any misdemeanor or felony citation, arrest, or conviction to Human Resources following hire.
Must submit to annual TB skin testing and comply with the KTHFS staff immunization policy and CDC recommendations for healthcare workers.
Must accept mandatory reporter responsibilities under the Klamath Tribes Juvenile Ordinance Title 2, Chapter 15.64 and General Resolution #2005 003.
Must submit a Klamath Tribal Health & Family Services employment application and required supporting documentation; Indian Preference applicants must submit proof of eligibility.

Nice To Haves

AAPC coder certification or AHIMA coder certification.
Experience with NextGen or another electronic health record system.
Knowledge of mental health and alcohol and drug coding and billing.

Responsibilities

Review and interpret patient EHR or paper encounters and chart notes, verifying diagnostic and procedural codes and medical necessity under applicable CMS guidelines.
Ensure billing records use appropriate ICD-10-CM, CPT, HCPCS, and CDT codes that correspond to the documented services.
Coordinate with providers, nursing staff, and Business Office staff to clarify documentation and address deficiencies affecting charge capture.
Prepare and submit accurate electronic or paper claims to primary and secondary Medicaid, Medicare, and private insurance payers.
Maintain compliance with billing regulations and payer requirements, including Medicaid, Medicare Parts A and B, DME, and private insurance.
Verify and post insurance check and EFT payments in the applicable tracking spreadsheet and NextGen system.
Process overpayment refunds and related claim adjustments, purchase orders, and NextGen account updates.
Process no-pay EOBs, apply adjustments, document follow-up, appeal improperly paid or denied claims, and contact payers to resolve unpaid claims or obtain requested information.
Record claim-related calls, correspondence, and activities in the NextGen patient account.
Maintain filing systems for encounters and purchase orders, and process incoming mail and correspondence.
Coordinate with Patient Registration and record patient benefit effective and termination dates in the practice management system as needed.
Create and reconcile electronic claim batches submitted through the clearinghouse, follow up on payer receipt, correct claims, and archive files.
Work outstanding accounts receivable by reviewing, rebilling, adjusting, tracking, and resolving pending claims and ensuring timely payment follow-up.
Monitor the Business Office Outlook inbox and back-bill or adjust claims when appropriate.
Run and work specified weekly reports, including pending charges, unbilled and rebilled encounters, printed paper claims, and clearinghouse denial, outstanding, removed, and rejected claim reports.
Run and maintain specified biweekly reports, including kept appointments with no encounters and aging reports, and address old billing.
Maintain effective working relationships with public and private payers and identify potential problems that may interrupt cash flow.
Participate in annual chart audits for quality assurance and document results for review by the Chief Medical Officer and Chief Quality Officer as needed.
Attend coding seminars, meetings, and training to remain current in the profession.
Assist with other Tribal functions, including sponsored cultural, traditional, or community events, as needed.