Medical Records Biller IV- Lead

Koniag Government Services•Oklahoma City, OK

2d•Hybrid

About The Position

Koniag Advisory Business Solutions (KABS) is seeking highly skilled, self-directed Medical Biller IV (Lead) professionals to support a large-scale healthcare mission serving hospitals and clinics. This role is designed for experienced billers who can manage complex claims activity, handle payer escalations, and serve as a technical resource to junior staff. In this role, you will support accurate and timely submission of third-party claims, resolve denials and payer issues, review documentation and coding-related billing data, assist with audits and appeals, and help improve billing quality across the team. This position is well suited for seasoned professionals who combine strong reimbursement knowledge with sound judgment and a proactive, solutions-oriented work style.

Requirements

High school diploma or equivalent plus 5+ years of progressively responsible 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 2+ years of progressively complex experience.
Advanced knowledge of outpatient and inpatient claim preparation, denial management, payer requirements, UB-04 and CMS-1500 billing, and accounts receivable follow-up.
Strong working knowledge of ICD, CPT, and HCPCS coding as used in billing support functions.
Experience with audits, appeals, post-payment review response, and payer communication.
Proficiency with EHRs, RPMS or comparable systems, billing platforms, and reporting tools.
Strong independent judgment, attention to detail, and analytical capability.
Must be able to obtain and maintain a favorable Tier II background investigation determination, as required by IHS.
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.
If telework is approved, the employee must maintain a dedicated, private workspace suitable for handling confidential information and must use only authorized equipment, approved connections, and secure access methods.
Final candidates will be required to provide documentation and information necessary to support background investigation, credentialing, and access processing, which may include: Government-issued identity documents for identity proofing. Information needed for fingerprinting and background investigation processing. Current address and prior residence history, as requested. Employment history and related verification information, as requested. Professional certification and training documentation, as required. Any other forms or supporting materials required by IHS, HHS, or authorized security officials.

Nice To Haves

Completion of an accredited Medical Billing, Medical Coding, Health Information Management, or related program preferred.
Experience working in Indian Health Service.
Expertise in Medicare, Medicaid, and commercial insurance billing requirements and reimbursement practices.
Ability to mentor new staff and build cohesive working relationships with team members.
Familiarity with HIPAA regulations and healthcare compliance.
Possess sufficient initiative, interpersonal relationship skills, and social sensitivity such that he/she can relate constructively to Native American communities.

Responsibilities

Oversees preparation and submission of complex outpatient and inpatient claims to third-party payers, intermediaries, and responsible parties in accordance with required timelines and internal controls.
Reviews daily system reports and monitors claim inventory to ensure timely processing, export, and transmission.
Responds to post-payment reviews, exclusions, denials, and appeals and assists with medical reviews and claim-level audit activity.
Ensures daily billing productivity reporting is accurate and that unbillable claims are identified, documented, and elevated appropriately.
Verifies that electronic billing transmissions are HIPAA compliant and that reconciliation and correction activities are completed promptly.
Maintains current knowledge of payer guidance, listserv updates, policy changes, and continuing education resources.
Performs advanced review of medical records to validate diagnoses, dates of service, provider signatures, attestation requirements, and documentation needed to support claim submission.
Identifies trends, discrepancies, and documentation issues and coordinates with providers, billing staff, and other departments to resolve problems before claims are transmitted.
Guides eligibility verification and insurance-identification review activities for complex cases and supports resolution of coverage issues.
Supports preparation and compilation of authorizations, benefits assignments, release forms, and pre-certification documents needed for payer approval and claim support.
Refers appropriate patients to Benefits Coordination or Social Services and helps staff navigate complicated eligibility situations.
Reviews patient records and billing data for outpatient and inpatient services and supports accurate sequencing of ICD, CPT, and HCPCS codes used in billing.
Ensures provider documentation supports billed diagnoses, procedures, and E&M levels and resolves discrepancies affecting reimbursement.
Monitors inpatient daily census and ADT-related issues and coordinates with admitting and utilization review personnel when system or workflow gaps are identified.
Maintains corrective action information from fiscal intermediaries and payers and shares findings with appropriate staff for reconsideration or appeal.
Prepares and reviews UB-04, CMS-1500, and other required forms for accuracy, completeness, and regulatory compliance.
Leads correction of rejected or suspended claims and supports collection activity by maintaining accurate documentation in RPMS or other approved systems.
Assists in establishing daily billing procedures, status tracking methods, and claim follow-up controls.
Communicates with DHHS operational personnel, fiscal intermediary staff, claims processing personnel, Social Security Administration, state medical offices, PRO personnel, and Service Unit staff to resolve challenging billing and systems issues.
Maintains communication with first-line billing leadership to support proper use of funds collected from third-party insurance under applicable Indian Health Care Improvement Act requirements.
Responds to ad hoc requests by defining information needs, structuring search strategies, and retrieving required data from approved systems.
Determines when data reconstruction, reruns, or restart actions may be needed to better align systems processing with billing requirements.
Acts as a lead contact for complex claims-processing questions and recurring billing problems and recommends changes in methods or procedures to improve outcomes.
Maintains confidentiality of Alternate Resources claims and medical records and ensures staff follow disclosure limits under IHS policy.
Helps prepare responses to inquiries elevated by facility leadership and follows up to ensure timely resolution.
Mentors new staff and provides technical guidance to Medical Biller III personnel as assigned.