Medical Biller

Tohono O'odham Nation Healthcare•Tucson, AZ

About The Position

Under general supervision, the Medical Biller examines, verifies, and maintains data used to process medical care claims for alternate-resource reimbursement and performs other third-party billing duties. The primary purpose of the position is to bill and process medical care claims promptly to obtain reimbursement from third-party payers. The role involves reviewing claims for accuracy and completeness, obtaining missing information, and performing accounting, budget, or financial-management support related to medical billing. The incumbent is responsible for claims from receipt through payment by the third-party payer. Duties include coding and abstracting medical records; preparing, submitting, tracking, and correcting claims; maintaining patient receivables and related records; and coordinating with providers, departments, payers, and Patient Registration. The position may require temporary relocation to other TONHC facilities: Sells Hospital, Santa Rosa Health Center, San Simon Health Center, and San Xavier Health Center.

Requirements

High school diploma or GED.
Two years of work experience in medical billing, third-party billing, accounting, budget, financial-management support, or equivalent.
Type at least 40 words per minute.
Knowledge of Tohono O'odham culture, customs, and traditions.
Knowledge of accounting, budget, and financial-management rules and procedures relevant to the medical-billing revenue cycle.
Knowledge of hospital admitting procedures and documentation, facility operations, and medical services provided by clinic subdivisions.
Knowledge of medical terminology, anatomy, common drugs, spelling, and medical abbreviations.
Knowledge of confidentiality laws and requirements, including HIPAA and the Privacy Act of 1974; familiarity with FOIA and other applicable privacy protections.
Knowledge of complex billing processes, billing and collections, accounting and budget functions, claims and eligibility systems, follow-up and adjustment procedures, and alternate-reimbursement policies and regulations.
Knowledge of Medicare and Medicaid regulations and other laws and regulations affecting third-party billing and alternate-resource programs.
Knowledge of Resource Patient Management System (RPMS), the Third Party Billing program, utilization review, and electronic billing systems.
Knowledge of ICD-10 and CPT-4/HCPCS coding, diagnostic and procedural sequencing, and DRG assignment considerations.
Knowledge of compliance rules and issues related to hospital coding and billing, including alternate-resource regulations and applicable Indian Health Service policies and statutes.
Excellent communication skills to train staff on changes through continuing education and communicate with medical staff.
Skill in typing and using basic word-processing, calculator, spreadsheet, and database software.
Skill in providing superior customer service to internal and external customers.
Ability to interpret and resolve problems using system-monitoring reports and UB-92 and HCFA-1500 billing forms.
Ability to analyze complex medical and regulatory information to determine an appropriate billing method.
Ability to maintain effective working relationships with employees, clients, and patients using tact.
Ability to handle multiple tasks and meet deadlines, exercise independent judgment, and follow verbal or written instructions.
Ability to communicate effectively verbally and in writing, establish positive working relationships, and maintain confidentiality.
Upon recommendation for hire, submit to a criminal background check, National FBI fingerprint check, and review of a 39-month driving record.
May be required to possess and maintain a valid driver's license, with no DUIs or major traffic citations within the preceding three years; if required to operate program vehicles, meet the Nation's insurance requirements for a driver's permit.
Depending on departmental needs, may be required to demonstrate fluency in both Tohono O'odham and English as a condition of employment.

Responsibilities

Receive and examine alternate-resource claims for completeness and appropriate supporting documents.
Verify health claim numbers, authorized amounts, and whether billed services are allowed under applicable regulations and other controlling guidance.
Identify errors, omissions, and duplicate information, and contact appropriate individuals to resolve issues before claims are approved and submitted.
Audit evaluation and management information and assign appropriate CPT/HCPCS codes; abstract operative, therapeutic, and other pertinent information from medical records.
Review records and coding to select accurate, descriptive codes under applicable CPT/HCPCS guidelines and official coding conventions.
Meet billing timelines, including outpatient claims within six business days of service, inpatient claims within ten days, and claims within 48 hours after all billing information is available.
Batch bills and prepare invoices and patient listings for submission to third-party payers, fiscal intermediaries, and other responsible parties.
Maintain transmittal logs for electronically transmitted claims and follow up on alternate-resource bills.
Serve as a contact for claims-processing and coding questions or problems, and recommend changes to methods and procedures to resolve recurring issues and expedite processing.
Verify that claims are correctly processed, control totals agree, and reports and listings are balanced and contain valid data in the proper format and sequence.
Maintain a timely filing system for third-party documents, remittance advice, transmittals, and payer notices about coverage or billing changes.
Provide technical assistance with CPT coding, outpatient chart abstraction, and regulatory compliance.
Identify inconsistencies in medical documentation and notify providers and relevant departments to support complete charge capture and abstraction.
Consult with attending physicians, laboratory personnel, and other departments about compliance requirements, including False Claims Act and facility compliance requirements, when preparing itemized bills.
Add and edit insurers in the insurer file, complete claim formats, and coordinate with Patient Registration to maintain the file.
Maintain and control unbilled claims for an assigned section of patient receivables and review system-generated reports daily for claims ready to bill.
Prepare and submit claims to payers, intermediaries, or responsible parties; correct errors on rejected or suspended claims in accordance with hospital policies and procedures.
Document claim activity and patient-account information in financial folders, including billing dates and contacts.
Provide the supervisor with accurate accounting of claims in the assigned receivables section and submit a daily productivity report showing beginning inventory, claims billed, and ending balance.
Maintain provider files, including current licenses, and complete provider applications for NPI, AHCCCS, and Medicare numbers.
Manage access to online insurance data, including usernames and passwords, and provide training on online use.
Use word-processing and other automated equipment to extract, list, transmit, print, format, file, and retrieve information.
Perform other job-related duties as assigned and contribute to a team effort.