Medical Records Tech (Biller) - OCAO - IHS

MCSG Technologies•Oklahoma City, OK

11d

About The Position

The Medical Records Technician – Biller supports management in planning and delivering Business Office Department services throughout the Oklahoma Area. The role is responsible for accurate, timely billing and collection of alternate resources for outpatient and inpatient services, including preparing and submitting claims to third-party payers, intermediaries, and responsible parties in accordance with hospital policies and applicable requirements. The position reviews medical records and billing documentation, verifies patient eligibility and insurance information, assigns and sequences diagnosis and procedure codes, and prepares and checks billing forms such as UB-04 and CMS-1500. It monitors claims through submission and payment, corrects rejected or suspended claims, responds to payer reviews, denials, exclusions, and appeals, and maintains patient-account activity and supporting records. The role also coordinates with internal staff, government agencies, insurers, and other organizations to resolve eligibility, documentation, coding, and claims-processing issues. The technician safeguards confidential health information and maintains records and reports required for billing, collections, compliance, and special projects. The position requires accuracy and timeliness, tact in dealing with employees and patients, and ongoing attention to payer requirements and related education. A background check is required, and the security clearance is Public Trust.

Requirements

Background check required.
Public Trust security clearance.
Extreme accuracy and timeliness in all phases of work.
Tact in maintaining effective working relationships with employees, clientele, and patients.
Working knowledge of accounting skills to maintain ledgers and registers and interpret computer printouts, vouchers, schedules, and financial coding reports.
Knowledge of third-party billing, claims processing, medical-record documentation, and applicable coding and billing requirements, as reflected in the listed duties.
Ability to communicate and coordinate with internal staff, patients, insurers, government agencies, and other organizations.

Responsibilities

Prepare and submit outpatient and inpatient claims accurately and within required timeframes to third-party payers, intermediaries, and responsible parties.
Review daily system-generated reports to identify claims ready for billing and mail or transmit approved claims within one business day.
Respond to third-party requirements concerning post-payment reviews, exclusions, denials, and appeals.
Audit claims and medical records through random sample reviews to verify documentation and accountability.
Notify the supervisor daily of claims deemed unbillable and provide the reasons.
Submit a daily billing productivity report showing beginning inventory, claims billed, and the remaining end-of-shift balance.
Verify electronic transmissions are HIPAA-compliant, reconcile transmission and confirmation reports, and correct errors.
Review medical records for required documentation, diagnoses, provider signatures, dates of service, and compliance with attestation and billing requirements.
Report documentation inconsistencies, discrepancies, and trends to appropriate providers or departments so they can be resolved before claims are transmitted.
Maintain a current system for checking patient eligibility and insurance information by contacting relevant Federal, State, and County agencies and notifying carriers within required periods.
Prepare and compile authorizations for medical-information release, assignment of benefits, prior approval, and pre-certification; obtain and retain required original or guardian signatures.
Refer potentially eligible patients to the Benefits Coordinator or Social Services Department for assistance obtaining health insurance.
Search and review patient health records to gather information for outpatient services and inpatient hospitalizations.
Assign and sequence applicable ICD, CPT, and HCPCS codes based on medical record analysis and verify diagnoses and procedures are valid, complete, and properly related.
Analyze provider documentation to assign appropriate Evaluation and Management levels and corresponding codes.
Monitor the inpatient daily census, verify admissions through the Admission Discharge Transfer system, and notify appropriate staff when system information is incomplete.
Share corrective actions from fiscal intermediaries or payers with the Utilization Review Coordinator for possible review and appeal.
Complete and review UB-04, CMS-1500, and other required billing forms, ensuring they accurately reflect services rendered and are submitted with applicable documentation.
Establish day-to-day billing procedures and recommend procedural changes to the supervisor.
Correct rejected or suspended claims and maintain current patient-account activity in the RPMS accounts receivable message field.
Complete special projects within required timeframes and maintain ledgers, registers, and financial records related to submittals and collections.
Safeguard alternate-resource claims and medical records as privileged communications, disclosing information only within IHS policy limits.
Maintain relevant payer manuals, directives, reimbursement materials, billing references, and coding updates.
Communicate with DHHS operations personnel, fiscal intermediaries, claims processors, the Social Security Administration, State Medical Office, PRO personnel, and Service Unit staff to identify and address application or system problems.
Maintain communication with the First Line Billing Supervisor regarding the use of funds collected from third-party insurance under applicable requirements.
Respond to ad hoc information requests by defining requirements, preparing logical search strategies, accessing appropriate data, and determining whether data must be reconstructed or systems requirements rerun or restarted.
Serve as a contact for claims-processing questions and problems, interpret regulatory and coding guidance, and recommend changes to methods, procedures, information dissemination, and processing.
Respond to administrative inquiries from Service Unit leadership, staff, Area Office officials, governments, hospitals, institutions, Federal agencies, and Tribal officials; coordinate timely responses.