Biller/Coder

Biller/Coder

Department: Revenue Cycle

Program: Health Systems

Reports To: Central Business Office Supervisor

Employment Status: Full Time

FLSA Status: Non-Exempt

Schedule: 40 Hours/52 Weeks

Preference: TERO Ordinance 2017-01, P.L. 93-638

Job Summary

The Biller/Coder supports all of the Health Systems Departments. The Biller/Coder is responsible for organizing un'ina (patient) medical records, reviewing previously assigned medical codes to chart notes and procedures for accuracy. The Biller/Coder will review claims prior to submission and collaborate with Central Business Office Supervisor when changes are needed to claims submitted. The Biller/Coder is responsible for claim submission to insurance companies to ensure proper payment is received for services rendered.

Essential Functions

• Ensure all patient records are accurately documented, organized, and updated within the health systems departments to include, Primary Care, Dental, Optometry, Laboratory, Therapy Services, Radiology, Pharmacy, Behavioral Health, etc
• Apply correct medical codes (ICD, CPT, HCPCS) to patient charts, notes, and procedures to facilitate accurate billing
• Examine claims for accuracy and completeness before submitting them to payers, identifying and correcting any errors
• Process and submit claims to insurance companies in a timely manner, ensuring compliance with payor requirements
• Collaborates with other departments to optimize revenue cycle management by preventing under-coding and over-coding issues
• Corrects codes as needed on rejected claims in collaboration with supervisor and Health Systems Departments
• Ensures proper documentation of Healthcare Common Procedure Coding System (HCPCS)
• Collaborates with Central Business Office Supervisor to provide training to all Health Systems Providers on billing and coding compliance
• Ensures compliance with Tribal, federal, state, and local employment laws and regulations, Tribal policies and TERO ordinance

It is the intent of this job description to highlight the essential functions of the position; however, it is not an all-inclusive list. The incumbent may be called upon and required to follow or perform other duties and tasks requested by his/her supervisor, consistent with the purpose of the position, department, and/or the Kenaitze Indian Tribe's objectives

Working Conditions

Lifting Requirements

Light work - Exerting up to 20 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg control requires exertion of forces greater than that of sedentary work and if the worker sits most of the time, the job is considered light work.

Physical Requirements

• Stand or Sit (Stationary position)
• Walk (Move, Traverse)
• Use hands/fingers to handle or feel (Operate, Activate, Use, Prepare, Inspect, Place, Detect, Position)
• Climb (stairs/ladders) or balance (Ascend/Descend, Work atop, Traverse)
• Talk/hear (Communicate, Detect, Converse with, Discern, Convey, Express oneself, Exchange information)
• See (Detect, Determine, Perceive, Identify, Recognize, Judge, Observe, Inspect, Estimate, Assess)
• Repetitive Motion

OSHA Categories

• Category III - Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid

Equipment and Tools

List Equipment used for job: Computer, phone, scanner, copier, electronic health records

List Tools:

Drives KIT or Personal Vehicle: Personal

Travel

• Local
• In-State
• Out-Of-State

Qualifications

Education

• High School Diploma or GED

Experience

• Two (2) years of experience in medical billing and/or coding
• Proficiency in electronic health records

Preferred

• Knowledge and experience working with cultural diversities
• Associates degree in related field
• Experience with Indian Health Services facilities operations
• Knowledge of ethical debt collection practices and insurance guidelines

License/Certification

• At least one of the following certifications: Certified Professional Coder Certified Professional Biller (CPC CPB) or Billing Coding Specialist Certification (BCSC)
• Must have a valid Alaska State driver's license and must remain insurable under the Tribe's policy, or obtain within 90 days of hire, or, with approval of the hiring manager, sign a *Memorandum of Understanding (MOU) in lieu of having a driver's license to perform the required duties of the position (If Applicable)

Special Skills

• Proficiency with Microsoft Suite, or obtain training within 90 days of hire
• Conducts business in a service-oriented manner that is attentive, pleasant, respectful and kind when dealing with un'ina, visitors, co-workers and others
• Ability to multi-task, work independently, and meet deadlines
• Understanding of coding guidelines for accurate billing and compliance
• Knowledge of insurance claim forms, submission processes, and payer-specific requirements
• High attention to detail and strong analytical and problem solving abilities
• Understanding of medical terminology and regulatory compliance
• Strong communication, collaboration, time management, and organizational skills
• Knowledge of billing and coding for Primary Care, Dental, Optometry, Laboratory, Therapy Services, Radiology, Pharmacy, Behavioral Health, etc.
• Knowledge of HCPCS guidelines
• Knowledge of ICD-10 and CPT codes
• Knowledge of medical terminology

This position is a Covered Position subject to all requirements of the Alaska Barrier Crimes Act (ABCA) and to the Indian Child Protection and Family Violence Prevention Act, (ICPA). ABCA and ICPA requirements apply and must be complied with at all times in order to remain in the position.

*Memorandum of Understanding: Serves as documented evidence that the Kenaitze Indian Tribe has expressed the ineligibility of an employee to operate motor vehicles owned, leased or rented by the Kenaitze Indian Tribe, or to operate a personal vehicle on behalf of the Kenaitze Indian Tribe.