Billing Coordinator

OHC Business Office · RAPID CITY, South Dakota
Department OHC Business Office
Employment Type Full-Time
Minimum Experience Entry-level

GPTLHB IS A MANDATORY VACCINATION ORGANIZATION THE EMPLOYEE IS RESPONSIBLE FOR PROVIDING PROOF OF INOCULATIONS BEFORE EMPLOYMENT



Job Summary:

 

The Billing Coordinator serves as an insurance Biller for all third party claims, including Medicare, Medicaid, VA and Private Insurance.  The billing coordinator will be responsible for the analysis of medical information from the electronic health record (EHR) encounter and the Resource and Patient Management System (RPMS) to ensure the timely submission of accurate claims to third-party payers.  The Billing Coordinator is responsible for the tracking and follow-up of all claims to confirm proper reimbursement is received as well as the correction or appealing of denials.


Essential Functions:

  • Prepare, process and submit clean claims to various insurance claims according to payer guidelines and deadlines either electronically or by paper.
  • Maintain current knowledge and understanding of each insurance payer’s rules, regulations and deadlines and apply this knowledge in daily duties and assignments
  • Recognize and identify errors and communicate these to insurance payers and/or Lead Biller.
  • Monitor and reconcile delinquent accounts.
  • Identify and resolve incorrect denials.
  • Documented ability to prioritize workload and meet quality and production standards.
  • Effectively communicate with clearinghouse and insurance companies regarding claim status, including rejections, denials, corrections and other various issues.
  • Communicate with coding department regarding coding-related denials needing correction.
  • Provide appropriate third-party account status and any issues to Lead Biller or Business Office Manager.
  • Responsible for daily clearinghouse reconciliation of reports and claims.
  • Answer questions from patients, clerical staff, tribes, subcontractors and insurance companies.
  • Perform various collection actions including contacting by phone, correcting and resubmitting claims to third party payers.
  • Participate in CMS, IHS and private insurers’ educational activities as necessary.
  • Conduct self in accordance with GPTCHB’s employee manual.
  • Maintain strict confidentiality; adhere to all HIPAA guidelines/regulations.
  • Perform other related duties as assigned.


Professional Behavior

  • Effectively plan, organize workload and schedule time to meet the demands of the position.
  • Work in a cooperative and professional manner with OHC and GPTCHB staff.
  • Treat Great Plains tribes and collaborators with dignity and respect.
  • Utilize effective verbal and written communication skills.
  • Advance personal educational development by attending training sessions and seminars as appropriate.
  • Exemplify excellent customer service with tribal stakeholders, health board colleagues, program partners, service recipients, visitors and guests.
  • Foster a work environment of wellness, courtesy, friendliness, helpfulness and respect.
  • Relate well and work collaboratively with coworkers and all levels of staff in a professional manner.
  • Consistently demonstrate respect for and acceptance of differing capabilities, cultures, gender, age, sexual orientation and/or personalities.
  • Maintain and ensure organizational privacy and confidentiality.
  • Handle crisis and tolerate stress professionally.
  • Be self-directed and take proactive initiative to assist others.
  • Resolve issues with other departments and coworkers without direct supervision if needed.
  • Exercise flexibility to alter plans/routines when situations require and continue to perform without projecting stress/frustration that would adversely affect the work environment.
  • Promote an alcohol, tobacco and drug-free lifestyle.
  • Embrace modes of appearance and attire that reflect a professional presence.
  • Adhere to GPTCHB policies and procedures.


Knowledge Required


  • Advanced knowledge of medical billing coding practices, Medicaid/Medicare, Worker’s Compensation, all commercial insurance carriers and other third party reimbursement resources.
  • Knowledge of medical billing and accounting procedures and applications.
  • Knowledge of claims review, analysis and quality assurance.
  • Knowledge of basic medical terminology including prefixes, suffixes, standard abbreviations, and pharmaceutical terminology and clinic processes.
  • Knowledge of third-party claims submission process and ability to keep current on changes in policies, regulations of eligibility.
  • Knowledge and skill sufficient to decipher terminology used by providers in EHR.
  • Knowledge of CMS and private insurer’s guidelines.
  • Knowledge of anatomy and physiology and major anatomical symptoms.
  • Knowledge of ICD-10 and CPT 4 and HCPCS coding procedures.
  • Knowledge of changes in government regulations, collection laws, third party procedures and internal procedures.
  • Skill in using a computer for analyzing encounters and notifying providers of data that needs corrections through the EHR broadcast, notifications and templates.
  • Exemplify excellent customer service with tribal stakeholders, health board colleagues, program partners, service recipients, visitors and guests.
  • Foster a work environment of wellness, courtesy, friendliness, helpfulness and respect.
  • Familiarity and/or experience working with American Indian populations and respect for and knowledge of traditional, cultural and spiritual practices of diverse American Indian communities, as well as an ability to work with other culturally and ethnically diverse populations.
  • Consistently demonstrate respect for and acceptance of differing capabilities, cultures, gender, age, sexual orientation and/or personalities.
  • Maintain and ensure organizational privacy and confidentiality.
  • Must be able to handle crisis and tolerate stress professionally.
  • Must be self-directed and take proactive initiative to assist others.
  • Possess the ability to resolve issues with other departments and coworkers without direct supervision.
  • Able to exercise flexibility to alter plans/routines when situations require and continue to perform without projecting stress/frustration that would adversely affect the work environment.
  • Ability to maintain a flexible work schedule, including evenings, weekends and overnight or extended travel as necessary.
  • Proficiency with computer programs (Word, Excel, PowerPoint) and other Internet technologies.
  • Valid driver’s license must be kept current, and certificates, credentials or licenses must be kept current and consistent with regulations required by applicable federal, state and/or grant regulations.
  • Ability to promote an alcohol-, tobacco- and drug-free lifestyle.
  • Embrace modes of appearance and attire that reflect a professional presence.
  • Adhere to GPTCHB policies and procedures.


Supervisory Controls

The supervisor makes assignments by defining objectives, priorities, and deadlines and assists the employee with unusual situations that do not have clear precedents.

The employee plans and carries out the successive steps and handles problems and deviations in the work assignments in accordance with instructions, policies, previous training, scope of license/certification, or accepted practices in the occupation.

Completed work is usually evaluated for technical soundness, appropriateness, and conformity to policy and requirements.  The methods used in arriving at the end results are not usually reviewed in detail.

 

Guidelines

Guidelines include regulations from federal, state and local alternate resource agencies; Department of Health and Human Resources Services regulations; GPTCHB, OHC, and department policies and procedures. These guidelines require judgment, selection and interpretation in application.  This position assists in the development of business office policies and guidelines.

 

Complexity/Scope of Work

The work includes some variations, and may involve different and unrelated processes and methods. The decision regarding what needs to be done depends upon the analysis of the subject, phase, or issues involved in each assignment, and the chosen course of action may have to be selected from many alternatives. 

 

Contacts

The personal contacts are with employees throughout the organization and are generally engaged in different functions and kinds of work, and may be representatives from various levels.  Other personal contacts at this level include contact with partner organizations, Tribal affiliate organizations, and members of the general public. 

 

Work Environment/Physical Demands

The characteristic demands 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 frequently required to stand, walk, sit and use hands to finger, handle or feel. The employee is often required to stoop, kneel, crouch or crawl. The employee must regularly lift and/or move up to 25 pounds and frequently lift and/or move up to 50 pounds. The employee is occasionally exposed to outside weather conditions. The noise level in the work environment is usually moderate.


Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


Travel: Minimal travel may be required to participate in required trainings.  


Supervisory and Management Responsibility

This position has no formally assigned supervisory responsibility or authority. The employee is responsible only for the performance of their own assigned work. They may be asked to train new employees in the fundamentals of the jobs or to participate in cross‑training of other employees in the department, but such assignments do not include the on‑going authority to assign and review work of other employees or to recommend or take corrective action with regard to other employees' performance.

 

Minimum Qualifications

  • High school diploma or equivalent required with one (1) year of medical office experience, sufficient to understand the major duties of the position; medical billing experience preferred.
  • AAPC or AHIMA certification required, or attainable within six (6) months.
  • Experience with RPMS and EHR preferred.
  • Excellent verbal and written communication skills with the ability to be detail oriented.
  • Computer and technical skills (including Word, PowerPoint, Excel, Outlook, etc.).
  • Experience that indicates the ability to interact effectively with leaders among American Indian communities, government agencies, scientific and academic communities, medical and health-related organizations, nongovernmental groups and the public at large is required.
  • Possession of or ability to readily obtain a valid driver’s license issued by the State of South Dakota.

 

The GPTCHB is a tribal organization which follows tribal preference laws. It is our policy to give preference to qualified Indian/Tribal candidates over qualified non-native candidates in hiring decisions, if all other qualifications are equal.

 

Must successfully pass a criminal and background check and a pre-employment drug screen.

Thank You

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  • Location
    RAPID CITY, South Dakota
  • Department
    OHC Business Office
  • Employment Type
    Full-Time
  • Minimum Experience
    Entry-level