What are the responsibilities and job description for the Billing/Coding Clerk position at Lower Elwha Klallam Tribe?
Biller is cross-trained in coding / billing and posting of payments for medical, behavioral health, dental and substance use disorder services for a tribal Federally Qualified Health Care facility. FQHC billing utilizes unique HCPCS codes and modifiers as required CMS and WA HCA. Data entry, claims billing and posting of payments utilizing NextGen practice management system and clearinghouse. Biller is knowledgeable in correct billing for federal and state plans, managed care organizations, worker's compensation and commercial insurances. Maintains compliance with state and federal regulations regarding HIPAA and confidentiality. Proficient in the use of medical, BH, dental and SUD terminology. Biller actively reviews claim denials and aging reports. Biller engages in courteous phone contact with insurance and / or patients / clients regarding claim issues.
BILLING / CODING CLERK :
ESSENTIAL FUNCTIONS OF THE JOB :
- Correct use of CPT, HCPCS, CDT and ICD-10CM codes
- Correct use of unique HCPCS codes and modifiers for tribal FQHC billing
- Perform basic data entry, coding, and claims production for multiple specialties
- Maintain compliance with state and federal regulations regarding confidentiality
- Daily retrieval and use of billing / coding information from patient electronic medical record
- Retrieve and submit claim batches via clearinghouse
- Utilize multiple insurance portals for verification and retrieval of processed claims
- Analyze and research rejected / denied claims for reprocessing
- Actively review aging reports for issues and rebilling
- Organize / maintain paperless filing systems of billing and payment records
- Assist providers / patients / clients in basic understanding of insurance coverage
- Communicate with staff regarding billing and collection issues
- Assist with patient / client payment plans agreements and / or sliding fee applications
- Available for receiving credit card payments as needed
- Assist / train clinic staff in accurate entry of services for coding and billing purposes
- Perform quarterly random internal audits for quality assurance and improvement
- Participate with LEKT Financial department on end of fiscal year audits
- Proficiency in the use of medical, BH, dental and SUD terminology
- Assist in developing reports as needed / required
- Completion of applications, forms and delivery of documents
- CEU's required for certification renewals
- Medtrainer courses as assigned by QA / QI officer
- Other duties as assigned
MINIMUM QUALIFICATIONS :
DESIRED QUALIFICATIONS :
OTHER DESIRED QUALIFICATIONS :
PHYSICAL DEMANDS :
WORKING CONDITIONS :
As with all positions of the Lower Elwha Klallam Tribe this position is Indian Preference in hiring, in Accordance with P.L. 93-638.