Billing Specialist

JOB SUMMARY:

The Billing Specialist is a major contributor to the revenue cycle for the Gerald L. Ignace Indian Health Center, Inc. The responsibilities include submission of properly executed claims on a timely basis to third party payers, guarantors, and other responsible parties. Follow-up on rejected, denied and open claims with third-party payors, intermediaries and responsible parties to ensure proper and timely reimbursement.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

* Responsible for the accurate and timely submission of claims to third-party payers, intermediaries, and responsible parties.

* Responsible for the maintenance and control of unbilled claims.

* Verify all billing control functions are completed daily.

* Responsible for reviewing rejected and denied claims and taking appropriate actions for claim resubmission to third-party payors within filing deadlines.

* Responsible for follow-up with third-party payors on open insurance claims.

* Assist with accounts receivable payment posting.

* Identify, document and bring to management's attention inconsistencies and patterns which result in negative impacts to the revenue cycle including claim rejections, claim denials, claim responses, and claim payment amounts.

* Keep up to date on coding trends and changes.

* Keep up to date on third-party payor updates and changes.

* Assist with all responsibilities of the billing process.

* Performs related duties as assigned by Management.

QUALIFICATIONS:

* Must have a working knowledge of the International Classification of Diseases (ICD-9-CM, ICD-10-CM), Current Procedural Terminology (CPT) coding and medical terminology.

* Strong understanding of reimbursement policies and procedures as they pertain to third-party payors, intermediaries, and responsible parties.

* Experience using office equipment including computers, telephones, copiers and fax machines.

EDUCATION and/or SKILLS/KNOWLEDGE:

* Associate degree in related field preferred.

* Dental billing knowledge is highly desirable.

* Experience in EPIC Systems preferred.

* Must be English proficient.

* Must have strong interpersonal skills and strong organizational skills.

* Must have excellent verbal and written communication skills.

* Must have a working knowledge and proficiency in Microsoft Excel and Microsoft Word.

OTHER SIGNIFICANT FACTORS:

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. While performing the duties of this job, the employee is regularly required to sit; use hands to manipulate objects, tools or controls; reach with hands and arms; and talk and hear. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus. Noise level in the work environment is usually quiet.

Work is performed in an office environment utilizing various office equipment including, but not limited to, a computer, copy machine, fax machine, and multi-line phone. Ability to communicate effectively over the telephone, by computer and in person. Ability to perform well in a fast-paced work environment.

This is a general outline of the essential functions of this position and shall not be construed as an all-inclusive description of all work requirements and responsibilities. The employee may be required to perform other job-related duties as requested by the designated work leader(s). All requirements are subject to change over time. All positions at the Gerald L. Ignace Indian Health Center have the responsibility to carry out functions to maintain inspection and survey readiness, participate in Quality Improvement initiatives, as well as assist in and/or provide education for health promotion and disease prevention. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

GLIIHC supports a safe, healthy and drug-free work environment through criminal and caregiver background checks and pre-employment drug testing. GLIIHC maintains a smoke-free environment.