• Reviews medical and behavioral claims for correctness of claims utilizing the ICD-10, CPT and HCPT code set. 
• Prepares and submit claims for Medicare, must have knowledge of Medicare coding guidelines.
• Maintains communication providers to ensure timely notification of identified documentation issues that may impact revenue or compliance. 
• Reviews all prior authorization received and attach to services for billing
• Create invoice and send to Tribal payor source, post payment when received in EHR.
• Analyze and monitoring denied claims; make appropriate adjustments for resubmissions or prepare for write offs.
• Make collections calls to payors for claims not paid after 60 days.
• Reconciling invoices with balance sheet reports and resolving any discrepancies. Complete and close any claims not paid within 90, prepare for charge off
• Attends quarterly meeting for MCOs, TRBHAs or RBHAs
• Works with Billing Manager on updating fee schedule and making updates according to CMS, and Medicaid changes. 
• Other duties as assigned

• High School or GED required.
• CPC(Certified Professional Coder), COC(Certified Outpatient Coder) or CCS(Certified Coding Specialist) or other qualified certification from an AAPC or AHIMA required.

• Knowledge of assigning and sequencing ICD-10, CPT, HCPC and modifiers codes.
• Knowledge of medical terminology, anatomy and physiology, knowledge of medical records requirements, HIPAA privacy rules.
• Working knowledge of Medicare, NCCI(National Correct Coding Initiative), LCD(Local Coverage Determination) and NCD(National Coverage Determination) and other claims edits.
• Familiarity with Medicare, Medicaid and other private insurance requirements.
• Experience in AHCCCS enrollment and benefit verification processes
• At least two years coding in a medical office
• Knowledge of HIMS/AXIOM preferred, or other EHR software
• Highly detail oriented
• Must be a team player, possess a strong work ethic and be able to coordinate multiple tasks while meeting require deadlines
• Possess excellent customer service, communication, organizational and interpersonal skills
• Excellent communication skills – written and oral
• Experience in working with the Native American population preferred
• Proficiency in MS Office, particularly Excel

Important Notes