Billing Specialist

TITLE: MEDICAL BILLING SPECIALIST

DEPARTMENT: FISCAL

SUPERVISOR: FINANCIAL SERVICES MANAGER

CLASSIFICATION: FULL TIME NON-EXEMPT

POSITION SUMMARY:

Processes Medical billing in accordance with Fiscal Policies and Procedures. Maintains all billing records and computerized billing software. Biller to optimize reimbursements from third party payers. Ensures that the goals and objectives of the department are consistent with LCTHC policy and any governmental regulations.

ESSENTIAL JOB FUNCTIONS:

• Responsible for completing insurance claims for designated third party payers in a timely manner,
• Responsible for correcting all errors in RPMS for orphan test, missing information, etc. prior to submission of claims to insurer.
• Responsible for assuring that all coding (CPT, ICD9, HCPCS, etc.) are applied and billed in the correct manner to the insurance company.
• Validates compatibility and medical necessity between CPT and ICD9 coding.
• Inputs computer information for electronic processing and edits of eligible claims (Medicare and Medicaid) and corrects any electronic rejections immediately through infinedi, LCTHC electronic clearing house.
• Prints, sorts and mails manual claim forms (private and dental) to insurer.
• Reviews insurance return mail and determines reasons for return and follows up the claim.
• Shares information on any significant changes in coding, benefits, coding errors, etc.
• Keeps in close contact with the insurer to better understand their specific billing rules and regulations.
• Researches all information related to a denied claim and processes a corrected bill in a timely manner, one that is established by the facility.
• Bills the appropriate primary insurer and follows up that secondary insurance is paid either manually or electronically.
• Keeps abreast of CPT, ICD9 and HCPCS coding and apply when necessary.
• Always respects the confidentiality of medical / charge information in performing job duties.
• Post payment on a timely basis, within month received.
• Generates monthly reports as requested by Chief Fiscal Officer
• Monitors accounts receivable aging for past due accounts and takes appropriate action in accordance with Fiscal Policies.
• Other duties as may be assigned

EDUCATION, EXPERIENCE, CERTIFICATIONS AND LICENSES:

• Ca driver’s license
• High School Graduate or GED
• Type 45 WPM
• Must posses math skills, telephone skills, medical terminology and computer knowledge
• Two years experience as a billing clerk
• Two years work experience in a dental field business office
• Previous experience with billing and accounts receivable
• Knowledge of medical / dental terminology
• Experience with training staff and good communication skills with customers
• Previous computer experience is essential
• Ability to effectively communicate and work well with others

All LCTHC employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the LCTHC policies and procedures as they may from time to time be updated.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Sitting / Mobility: Approximately 70% of time is spent working at a desk. Balance of time (approximately 30%) is spent moving around work areas. Communication: Ability to effectively communicate with co-workers, Board members, members of outside agencies, in person, by telephone, and by email. Vision: Ability to effectively use a computer screen and interpret printed materials, memos, and other appropriate paperwork. Lifting / Carrying: Ability to occasionally lift and/or move objects weighing no more than 25 pounds. Stooping / Kneeling: Ability to access files/stock supplies in low cabinets and shelves. Reaching / Handling: Ability to input information into computer systems and retrieve and work with appropriate paperwork, equipment, and supplies. Use of standard office equipment, including computer, telephone, calculator, copiers, and fax. Work is performed in an office/clinic environment; continuous contact with other staff and the public.

INDIAN PREFERENCE: Preference may be given to qualified Native American Indians according to the Indian Preference Hiring Act, CFR 25 USC 472. Other than Indian Preference, Lake County Tribal Health Consortium, Inc. adheres to all provisions of the Equal Employment Opportunities Act.

NOTICE OF DRUG-FREE WORKPLACE ACT REQUIREMENT: LCTHC is committed to maintaining a drug free and alcohol free workplace. LCTHC believes that a healthy, productive workforce free from the effects of drugs is very important to all employees and patients. Substance abuse is incompatible with the health, safety, efficiency and success of LCTHC.

Employees who are under the influence compromise LCTHC’S interests, endanger their own and the health and safety of others and can cause a number of other work-related problems. As a condition of employment, each applicant receiving a job offer from LCTHC must take and pass a required drug screen test.

HIPAA Health Insurance Portability and Accountability:

This act was enacted to deal with three main areas with regard to patient information.

• Security of health information
• Standards of electronic transactions
• Privacy of individually identifiable health information

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Lake County Tribal Health is an At-Will Employer. Either the employee or LCTHC can terminate the employment at will, without advance notice, at any time, with or without cause