LOWER ELWHA KLALLAM TRIBE
Job Description
Billing/Coding Clerk
Overview:
Billing/Coding Clerk: This position performs coding, data entry, and utilizes billing modules to enter and track billable claims to Medicaid, State Industrial, private and some Medicare Advantage insurers, maximize third party reimbursement, and Pre-Authorize all procedures that require authorization. The Billing/Coding Clerk also engages in heavy, courteous phone contact with insurance companies and patients as part of the collections process.
WORK LOCATION: The Lower Elwha Klallam Tribe Medical Clinic
SUPERVISED BY: Office Manager
POSITION STATUS: FTE, with full benefits
SALARY LEVEL: DOQ
WORK SCHEDULE: Full time, 40 hours per week, Mon-Fri
BILLING/CODING CLERK:
ESSENTIAL FUNCTIONS OF THE JOB:
- Perform basic coding, data entry, and claims production for all types of billing entities for multiple specialties
- Input claims into Provider One by direct data entry (DDE), and all others via tribal clinic electronic or paper claims submission
- Completes pre-authorizations for services, approves and exports claims both electronically and on paper, updates information in the data system, and checks for Insurance maximum limits after treatment plans are in place
- Data entry and billing for medical procedures with CPT and ICD-9 codes experience
- Works with providers and patients on determining the extent of insurance coverage, sets up/collects co-pays and payment plans.
- Accurate posting of charges into the data base
- Submit charge batches for coded individual visits
- Daily retrieval and use of billing and coding information from patient records as necessary
- Dedicates regular attention to analyzing rejected claims, researches and performs collections activities
- Assists and trains in assuring accurate entry of all dental/medical information in the patient encounter forms for the purpose of billing all services/or Electronic Medical/Dental Record
- Develop proficiency in the use of dental/medical terminology
- Work with data entry specialist on accuracy and quality control
- Assist in developing reports as needed and required
- Engage in paperwork completion as needed, such as completion of applications, forms and delivery of documents
- Daily communication with patients and staff regarding billing and collection issues
- Provide explanations of insurance benefits and regulations to patients
- Compliance with confidentiality policies
- Organizes and maintains an efficient filing system
- Performs other duties as assigned to support revenue recovery
MINIMUM Qualifications:
- 3-5 years work experience in a Medical office environment with excellent customer service skills
- Must be able to attend trainings pertinent to position
- Current Washington State driver license and insurable under State of Washington
- Must past Background Check and UA testing prior to employment
- Must observe the Alcohol policy which could include pre-employment drug testing
- Must have 3-5 years experience in Dental and/or Medical Coding/Billing or office experience that performed medical procedures.
DESIRED QUALIFICATIONS:
- Associates Degree or Billing Coding Certification
- Basic computer skills in word processing and spreadsheets
- Ability to operate computers, faxes, telephones and photocopy machines
- Training or Certification of Medical/Dental Billing and Coding.
- Ability to work as a team member with other office personnel
- Ability to maintain and respect strict confidentiality
- Ability to maintain friendly and courteous manner in all patient and staff encounters
- Ability to read, understand and follow written and oral instruction
OTHER DESIRED QUALIFICATIONS:
- Experience with Resource and Patient Management System (RPMS)
- Experience with Electronic Dental Record (EDR) Dentrix preferred.
- Experience with Electronic Health Records (EHR)
- Experience with Electronic claims submission
- Experience with a Tribal clinic
- Understanding of medical/dental terminology
PHYSICAL DEMANDS:
Requires standing, sitting, stooping and bending intermittently
Requires ability to lift up to 25 lbs. infrequently
Requires ability to see /understand colors, alpha and numerical characters, and have visual acuity
Requires ability to hear and understand verbal instructions
Requires use of standard office equipment such as computers, phones, faxes, and photocopiers
WORKING CONDITIONS:
Work is performed in a medical/dental office environment
Involves interpersonal contact with staff, patients and agency
Must follow all Policies and Procedures that are in effect for the Health Department.
As with all positions of the Lower Elwha Klallam Tribe this position is Indian Preference in hiring
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