Medical Records Tech (Biller) - OCAO - IHS

JOB SUMMARY: Medical Records Technician - Biller to provide support to management in the planning and services of the Business Office Department throughout the Oklahoma Area.

PRIMARY DUTIES:

Alternate Resource Billing Program

• Responsible for the accurate and timely preparation and submission of outpatient and inpatient claims to third party payers, intermediaries, and responsible parties according to established hospital policy and procedures. Analyzes, maintains, and focuses on the total billing operation for third party programs, and acts as an advocate for Indian Health Service in the collection of Alternate Resources.
• Reviews system generated reports daily to identify claims that are ready for billing. Prepare and submit claims to third party payers, intermediaries or responsible parties within the allowed time frame of the Third-Party Internal Controls Policy for outpatient and inpatient claims.
• Responds to third party requirements on post-payment reviews, exclusions, denials, and appeals. Actively performs audits and medical reviews to ensure documentation and accountability on all health insurance claims submitted for payment by conducting random sample reviews of claims and medical records.
• Notifies supervisor of all claims deemed unbillable, along with reason(s) on a daily basis. Submits a daily billing Productivity Report, to supervisor, reflecting beginning inventory, claims billed and remaining balance at end of shift. All claims awaiting export are mailed or transmitted within one business day from approval. Generates and verifies that all electronic transmits are HIPPA compliant. On a daily basis, electronic transmission and confirmation reports are reconciled and errors corrected.
• Responsible for self-education by reading third party list serves, newsletters, periodicals, e-mails and updates circulated by management. Attends all continuing education opportunities made available.

Verification Data

• Performs qualitative and quantitative analysis by reviewing the medical record to ensure it contains proper documentation in accordance with regulations, including proper diagnoses, physician/physician assistant original or electronic signatures(s}, accurate dates of medical care services, and that primary care providers are in compliance with attestation and billing requirements. Ensures that the final diagnosis accurately reflects the care and treatment rendered.
• Identified inconsistencies or discrepancies and or trends within in medical documentation will be reported to the appropriate individuals/providers or all other departments within the facility to resolve problems before claims are transmitted to third party payers. Maintains a current checking system on each patient receiving medical care from this facility. This consists of contacting various Federal, State, and County agencies to verify current eligibility for third party health insurance and their identifying numbers. Notifies the insurance carrier within the periods required. Knowledge of eligibility resources, and their processing applications.
• Directs the preparation and compilation of authorizations for release of medical information, assignment of benefits, and other authorizations for obtaining prior approval and pre-certification. Gathers and compiles, types patient's current address of residency, and mails such forms to obtain original signature(s) to be retained in filling file for the release of medical information needed to determine benefits or benefits for related health care services for all third-party billing purposes and processes. If patient remains un located, incumbent contacts various other next of kin regarding patient(s) residence status and seeks to obtain original signature and/or guardian's signature for the patient sought.
• Initiates the referral of potentially third-party eligibility patients to the Benefits Coordinator or Social Services Department for assistance in obtaining health insurance under these programs.
• Position requires extreme accuracy and timeliness in all phases of work. Incumbent must exercise considerable tact in maintaining effective work relationships with various employees, clientele and patients.

Claims Process/Account Receivable

• Searches and reviews individual patient health record(s) to gather and compile information for outpatient services and inpatient hospitalizations.
• Assigns and sequences a variety of codes including but not limited to ICD/CPT/HCPCS codes based on the medical record analysis. Assures the final diagnoses and operative procedures as documented by the provider are valid and complete. When multiple diagnoses and procedures are listed, assures the procedure is related to the proper diagnosis.
• Analyzes provider documentation to assure the appropriate Evaluation & Management (E & M) levels are assigned using the correct CPT/HCPC code.
• Monitors inpatient daily census on a concurrent basis. Researches Admission discharge Transfer System (ADT) to verify admitting confirmation. In the event the ADT system is not complete, the admitting staff and the Utilization Review Coordinator will be notified to ensure that appropriate utilization, review and PRO procedures are followed relative to the Alternate Resources program.
• Maintains identified corrective action received from Fiscal intermediaries or third-party payers to be shared or communicated with the Utilization Review Coordinator for review of diagnoses, length of stay, or coding transactions for possible reconsideration and appeal for payment.
• Responsible for billing the applicable agency for services provided to a patient on an outpatient and inpatient basis. The incumbent will complete the UB-04 and/or CMS-1500, or other required billing forms, and review for accuracy the billing and coding information on the UB-04 and/or CMS-1500 prior to submission.
• Ensure that all applicable forms are submitted and adequately reflect the services rendered. Because of the complexity of these billing forms used, incumbent must exercise extreme care in the preparation of these billings. Incumbent is responsible for establishing day-to-day billing procedures; i.e., tickler, files, individual patient files, status files for all third-party programs and recommends changes in procedures to supervisor. Responsible for the error correction for all rejected/suspended claims previously submitted to third party payers and intermediaries and patients according to the third-party internal controls and debt management policy. Maintains current documentation and all activity performed on patient accounts in the accounts receivable message field of RPMS.
• Completes special projects within required period to ensure compatibility of project specifications.
• Safeguard the contents of the Alternate Resources program health insurance claims and Medical Records as a privileged communication with disclosure of information only within the limits of IHS policy and therefore, at the discretion of the Service Unit Director.
• Must have working knowledge of accounting skills to maintain ledgers of submittals and collections, commitment registers, interpret computer printouts, vouchers and schedules derived from system financial coding report and data.
• Maintains Medicare, Medicaid, and Private Insurance manuals, and directives; Provider Reimbursement Manual; Direct Dealing Provider Letters; Federal Health Insurance for the Aged; Transmittal of Bills; Vouchers and Schedules and any addendum to the ICD-9/ICD-10 Coding Volumes.

Benefits Coordination Function

• Communicates primarily with DHHS operation personnel; Fiscal Intermediary Administration and Claims Processing personnel; Social Security Administration; State Medical Office; PRO personnel; and Service Unit staff to identify problems with applications and operating systems that are difficult to pinpoint. Follows up on suggested methods.
• Maintains communication with First Line Billing Supervisor to ensure that expenditures of funds collected from third party insurance meet the conditions and requirements as stated in Title IV of P.L. 94.437, 'The Indian Health Care Improvement Act".
• Responds to ad hoc request by advising and defining requirements necessary to provide the information needed. Accesses appropriate data after preparing a logical search strategy and structuring the requirement in acceptable identifiers.
• Determines need to reconstruct data from back-up files, rerun or restart requirements in order to better align or better apply systems program in relation to jobs on the schedule.

Administrative Support

• Acts as an advocate for Indian Health Services in the collection of Alternate Resources. Serves as contact person relative to any questions or problems with claims processing. Such contacts involves a variety of program and coding related matters, interpretation of regulatory material and determining the applicability of guidelines and instructions to problems or situations which in many instances, are not specifically covered. Makes recommendations for changes in methods and procedures, information dissemination and other processing matters to resolve recurring problems and expedite processing actions.
• Responds to inquiries and administrative problems brought to the Service Unit Directors' office by member of the staff and official of the Area Office, State and local governments, other hospitals and institutions, other Federal agencies, and various Tribal officials. Notifies the appropriate staff officials of the need for information or recommendations, and either prepares the response or follows up to ensure a timely response by others.

EDUCATION/CERTIFICATION:

• Background check required.

SECURITY CLEARANCE:

• Public Trust

ABOUT US: At MCSG Technologies, we believe the path to success begins by empowering our employees to do what is best for our customers. This helps create value for our customers and business partners through efficiencies and cost-effective relationships that are built on trust, while delivering on-time and within budget. Our company ethos is simple Empowered to serve our customers, our communities, our colleagues. If you would like to learn more, please visit our website at www.mcsgtech.com or find us on Glassdoor.

BENEFITS OFFERED: Medical, dental, vision, life insurance, short-term disability, long-term disability, 401(k) match, flexible spending accounts, EAP, parental leave, paid time off, holidays and more. Learn more about MCSG Technologies benefits: https://www.mcsgtech.com/benefits/.

COLORADO'S EQUAL PAY ACT: In compliance with Colorados Equal Pay for Equal Work Act; MCSG Technologies considers several factors when extending an offer, including but not limited to, the role and associated responsibilities, a candidate's work experience, education/training, and key skills.

EOE STATEMENT: We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, disability status, protected veteran status or any other characteristic protected by law.

EXECUTIVE ORDER 14042 ENSURING ADEQUATE COVID-10 SAFETY PROTOCOLS: The United States government may require that all employees, plus all contract employees performing services on behalf of the federal government, be fully vaccinated against COVID-19. In accordance with EO 14042, MCSG Technologies may require that all employees with MCSG Technologies be fully vaccinated against COVID-19.