Medical Records Biller III

Koniag Government Services•Oklahoma City, OK

2d•Hybrid

About The Position

Koniag Advisory Business Solutions LLC, a Koniag Government Services company, is seeking a Medical Records Biller III to support KABS and our government customer in Oklahoma, OKC. This position requires the candidate to be able to obtain a Public Trust. This position is covered under the Service Contract Act. Koniag Advisory Business Solutions (KABS) is seeking detail-oriented, dependable Medical Biller III professionals to support a large-scale healthcare mission serving hospitals and clinics. This role supports timely, compliant billing and follow-up activity for outpatient and inpatient claims and helps protect revenue integrity across third-party billing operations. In this role, you will review patient records and billing data, prepare and submit claims, correct errors, support account follow-up, and help ensure required documentation is complete before claims are transmitted. This position is well suited for billers with a solid foundation in medical billing and reimbursement who are ready to perform in a high-volume, mission-driven environment. The purpose of this position is to abstract and interpret coding and billing data from patient health records in preparation for the accurate and timely submission of outpatient and inpatient third-party claims. Under general supervision, the Medical Biller III performs day-to-day billing, verification, rebilling, and account follow-up activities; supports resolution of rejected or suspended claims; and helps ensure compliance with payer requirements, internal controls, and documentation standards.

Requirements

High school diploma or equivalent plus 3+ years of medical billing, claims processing, patient accounts, or revenue cycle experience; or an associate’s or bachelor’s degree in Health Information Management, Medical Billing and Coding, Business, or related field with 1+ years of relevant experience.
Working knowledge of outpatient and inpatient claim preparation, payer requirements, UB-04 and CMS-1500 claim forms, and accounts receivable follow-up.
Working knowledge of ICD, CPT, and HCPCS coding as used in billing support functions.
Proficiency with electronic health records, billing systems, encoder tools, and Microsoft Office applications.
Strong attention to detail, time management, and analytical ability.
Must be able to obtain and maintain a favorable Tier II background investigation determination, as required by the Indian Health Service (IHS), as a condition of access to IHS facilities, systems, and data.
Must successfully complete all required fingerprinting, identity proofing, credentialing, badge, and access steps.
Must complete required privacy, HIPAA, and IT security training within required timeframes and maintain current status thereafter.
Must comply with all IHS, HHS, facility, and company privacy, confidentiality, records management, and cybersecurity requirements.
Must protect PHI and other sensitive information in both paper and electronic form using required administrative, technical, and physical safeguards.
Must immediately report suspected privacy breaches, improper disclosures, security incidents, malware events, lost devices, or unauthorized access.
Must use only authorized systems, accounts, devices, software, and remote-access methods.
Must maintain workstation, password, and badge security at all times.
Must be able to support periodic access reviews, audits, and compliance checks.

Nice To Haves

Completion of an accredited Medical Billing, Medical Coding, Health Information Management, or related program preferred.
Experience working in Indian Health Service, tribal healthcare, or other federal or hospital-based environments.
Familiarity with RPMS/EHR and third-party billing workflows.
Knowledge of Medicare, Medicaid, and commercial insurance billing requirements.
Ability to build effective working relationships with providers, benefits staff, and business office personnel.
Possess sufficient initiative, interpersonal relationship skills, and social sensitivity such that he/she can relate constructively to Native American communities.

Responsibilities

Prepares and submits outpatient and inpatient claims to third-party payers, intermediaries, and responsible parties in accordance with established policy and required timeframes.
Reviews system-generated reports daily to identify claims ready for billing and supports timely export, transmission, or mailing of claims.
Maintains daily billing productivity logs and reports beginning inventory, claims billed, and end-of-shift balances.
Notifies the supervisor of claims deemed unbillable and documents the reasons for delay or non-bill status.
Reconciles electronic transmission and confirmation reports and corrects routine transmission errors.
Stays current on payer updates, billing procedures, and continuing education materials provided by management.
Performs qualitative and quantitative review of the medical record to verify required documentation, valid diagnoses, dates of service, provider signatures, and billing prerequisites.
Identifies documentation inconsistencies, discrepancies, or missing information and routes issues to the appropriate staff for correction before billing.
Verifies insurance eligibility and identifying information using applicable federal, state, county, and payer resources.
Supports preparation of authorizations, release forms, assignment of benefits, and pre-certification materials needed for billing and payment processing.
Refers potentially eligible patients to Benefits Coordination or Social Services staff for assistance in obtaining coverage when appropriate.
Searches and reviews patient health records to gather information for outpatient services and inpatient hospitalizations.
Assigns and sequences ICD, CPT, and HCPCS codes as required for billing support and validates that diagnoses and procedures are properly related.
Reviews provider documentation to support the appropriate Evaluation and Management (E&M) level and correct CPT/HCPCS assignment.
Prepares UB-04, CMS-1500, and other required billing forms and reviews each claim for completeness and accuracy prior to submission.
Corrects rejected or suspended claims previously submitted to payers, intermediaries, or patients in accordance with internal controls and debt management policy.
Maintains current documentation of all activity performed on patient accounts in RPMS or other approved accounts receivable systems.
Supports special projects and routine account follow-up assignments within required timeframes.
Communicates with payer representatives, agency personnel, and facility staff to identify and resolve billing issues.
Responds to ad hoc requests for billing information using approved search strategies and system identifiers.
Supports maintenance of manuals, billing references, and current directives used in daily billing operations.
Acts as a professional point of contact for routine claims-processing questions and assists in resolving recurring billing issues.
Maintains confidentiality of Alternate Resources program claims and related medical records within IHS policy limits.
Supports inquiries brought forward by facility leadership and follows up as needed to ensure timely responses.