Revenue Coding Specialist I

Confederated Tribes and Bands of the Yakama Nation•Toppenish, WA

6h•$27

About The Position

The purpose of this position is to abstract and code a patient's health record, according to federal, state, and tribal rules and regulations that will help process third party billing. This position will process claims and requires substantial experience and understanding of healthcare billing industry including ICD-10 + CPT coding. Responsibilities entail capturing patient demographics from 2 clinic facilities, entering, reviewing, and preparing patient and insurance date into e-clinical works system, researching, and verifying accuracy of billing data and the revision of billing errors including adjustments and denials. This position will also serves as a Tribal Assister, Navigator to provide patients with a basic overview of insurance, including common terms, background on the Affordable Care Act, the Health Benefit Exchange, and Washington Healthplanfinder.

Requirements

High School Diploma or GED with 2-4 years of experience in medical billing or medical data entry.
CPB-(Certified Professional Biller) or CPC-(Certified Professional Coder) certificate from American Academy or Professional Coders.
Must maintain high level of confidentiality, abide by HIPAA, and protect sensitive client and staff information. (Required).
Must pass pre-employment background check.
Must possess a valid Washington State Driver's License and proof of insurance.
Required to pass a pre-employment drug test.

Nice To Haves

Three years work experience with Native American communities and /or Tribal Health Billing is preferred.
Tribal Assistor Certification preferred or able to obtain within 90 days.
Documented training and experience in maintenance of medical records and ICD-10-CM/DRG coding.
eClinical works and/or E H R systems experience is preferred.
Enrolled Yakama Prefernece, but all qualified applicants are encouraged to apply.

Responsibilities

Responsible for reviewing patient logs, demographic, insurance eligibility and other activity to ensure billing is captured for all patients and completed accurately.
Safeguards confidentiality of the medical charts/electronic health records and complies with all federal, state and tribal laws pertaining to medical records.
Assures compliance with HIPAA regulations concerning use, retrieval, storage, and sharing of medical records.
Monitor insurance electronic claim billing process is completed successfully on a daily basis.
Report billing discrepancies to Revenue Specialist II.
Stay up to date on current coding and billing regulations and departmental policies.
Assist with third party payer and other audit request, by compiling and organizing documentation.
Coordinate the process of patient eligibility through various third-party sources and issue adjusted, corrected, and/or rebilled claims to third party payers.
Educate and aid clients and their families with the insurance application process through the Healthcare Exchange, using the web portal or by calling the Exchange Call Center.
Assist patients with signing up for Medicate plans: B, D & F, with Washington Connections Applications, and with filing exemptions for those who opt out of ACA.
Verify provider licensing with WA State Department of Health requirements for Substance Use Disorder Professionals, trainees, agency affiliates for legal, privileging and credentialing purposes.
Adherence to I.H.S. ISDEAA PL 93-638 contract, CMS, and I.H.S. Memorandum of Agreement to facilitate Medicaid billing, follow State of WA for amendments and changes to State plan provision that may affect billing.
All records will be maintained in accordance with Indian Health Services Standards, (I.H.S. Health manual, part 3, Chapter 18, and Washington State Department of Health (WAC 246-809035).
Ability to utilize Yakama Nation Tiinawit health information systems, RPMS E.H.R. (BH-MIS), Electronic Health Record (eCR, Target-treatment & assessment report generation tool, will be used to maintain records and collect date).
Assisting with setting up program to change data collection system from Targe to B.H.D.S-(behavior health data store system).
Billing Specialization-preparing billing files of claims and encounters to ensure that all services are reported.
Ensure that procedure codes and diagnosis codes are aligned with the documentation in the client record.
Monitor claim and encounter files submissions, review rejected claim and encounter reports, research and resolve errors in rejected claims.
Ensure all encounters and claims are resubmitted after correction.
Knowledge and understanding of the Medicaid, private insurance, employee insurance and the special provisions in the Affordable Care Act regarding American Indian/Alasa Natives.
Ability to utilize accessing OHP-OneHealthPort to access ProviderOne, for pt eligibility, access paid/denied claims, submit adjusted claims, verify EOB-explanation of benefits to verify payment.
A working knowledge of medical terminology and physiology and legal aspects of health information
Knowledge of accreditation standards and compliance requirements.
Ability to successfully lead and coach clinical/SUD staff in completing patient documentation for claims processing properly.
Partner with outside providers, coordinating external services with client's insurance information and PRC, resolving referral coverage inquires, and assistance with applying for insurance coverage.
Ability to establish and maintain effective working relationships with co-workers, employees, administrators, vendors, patients, and the general public.
Proficient with personal computers and have knowledge of software programs including Microsoft Outlook, Microsoft Word, Microsoft Excel, and PowerPoint and have the ability to utilize the internet.