BILLER/CODER

VACANCY ANN#:    STOI-25-117

TITLE:                           BILLER/CODER

DEPARTMENT:          DCWMHC

SUPERVISOR:            PATIENT SERVICES REPRESENTATIVE SUPERVISOR

LOCATION:                 WELLPINIT, WA

STATUS:                      NON-EXEMPT, FULL-TIME

RATE OF PAY:            $25-$35 PER HOUR/DOQ

OPENING DATE:       DECEMBER 22, 2025

CLOSING DATE:       OPEN UNTIL FILLED

INTRODUCTION:

The Biller/Coder is responsible for ensuring accurate and compliant coding, billing, and claim submission for all clinical services provided at the Tribal health center. This role supports the integrity of the revenue cycle by reviewing provider documentation, assigning appropriate ICD-10, CPT, and HCPCS codes, and ensuring timely submission of clean claims to Medicaid, Medicare, private insurance, and Purchased/Referred Care (PRC) where applicable. The position also helps maintain eligibility documentation, monitors denials, and collaborates with clinical and administrative staff to ensure proper documentation and reimbursement.

ESSENTIAL DUTIES & RESPONSIBILITIES:

Medical Coding

• Review provider documentation to assign accurate and compliant ICD-10, CPT, and HCPCS codes.
• Ensure documentation supports all levels of service, procedures, and modifiers.
• Monitor coding accuracy and provide feedback to providers as needed.
• Maintain current knowledge of coding regulations, payer guidelines, and Tribal/IHS billing requirements.

Medical Billing & Claims Management

• Prepare, verify, and submit clean claims electronically and manually to third-party payers, including Medicaid, Medicare, commercial insurance, and PRC.
• Correct and resubmit denied or rejected claims in a timely manner.
• Post payments, adjustments, and denials accurately in the practice management system.
• Reconcile daily billing activity and maintain claim tracking logs.

Patient Registration & Eligibility Support

• Verify patient information, insurance eligibility, and benefits; ensure accurate data entry in EHR/PMS systems.
• Document Tribal enrollment status when applicable for PRC, waiver programs, or differential benefits.
• Assist with sliding fee program documentation and self-pay arrangements.

PRC (Purchased/Referred Care) Coordination (if applicable)

• Ensure claims are routed correctly based on PRC eligibility and referral requirements.
• Verify documentation meets PRC requirements for medical priority, timely filing, and alternate resource use.

Compliance & Documentation

• Ensure compliance with HIPAA, CMS, IHS, Tribal policies, and federal billing regulations.
• Participate in audits and quality improvement initiatives.
• Maintain organized electronic claim files and ensure timely follow-up on outstanding accounts.

Interdepartmental Collaboration

• Work closely with providers, nursing, registration, and PRC staff to resolve coding/billing discrepancies.
• Provide training or guidance on documentation improvement and coding accuracy.

Core Competencies

• Accuracy and attention to detail
• Strong understanding of coding guidelines and audit standards
• Excellent communication and problem-solving skills
• Ability to work independently and meet deadlines
• Cultural competence and respect for Tribal sovereignty and community values

Work Environment

• Office/administrative environment within a Tribal health clinic.
• May require minimal travel for training or continuing education.
• Must comply with all Tribal, federal, and clinic policies, including confidentiality and cultural sensitivity expectations.

MINIMUM QUALIFICATIONS:

Required

• High school diploma or GED.
• Certified Professional Coder (CPC), CCS, CCA, or equivalent medical coding certification.
• Minimum 1–2 years of coding or billing experience in a healthcare setting.
• Knowledge of ICD-10, CPT, and HCPCS coding systems.
• Working knowledge of Medicare, Medicaid, and commercial payer billing rules.
• Proficiency with EHR/PMS software (RPMS, NextGen, Athena, etc.).

Preferred

• Experience working in a Tribal, IHS, 638, or FQHC setting.
• Knowledge of PRC, alternate resource rules, and Tribal enrollment verification.
• Familiarity with sliding fee programs and federal poverty guidelines.

In accordance with the requirements of the Health Center Manual, employee of this position, as a condition of employment, must document immunity to Rubella & Measles. Influenza vaccine is recommended for all health workers in contact with patients.

The employee must be suitable for Tribal employment in your position as determined by fingerprint check results and appropriate background investigation. An incumbent found not suitable after hire will be removed from this position.

The employee is required to operate a tribal-owned or leased motor vehicle, commercial motor vehicle, rental motor vehicle or privately owned motor vehicle in the performance of official duties. An appropriate, valid driver's license is required for the position.

Tribal Preference Policy: In accordance with the Spokane Tribal Employment Rights Ordinance Tribal Preference will be observed in hiring.

Veteran’s Preference: It shall be the policy of the Spokane Tribe to provide preference in hiring to qualified applicants claiming Veteran’s Preference who have been discharged from the United States Armed Forces with honor and under honorable conditions.

Contact: Donnie Lebret, DCWMHC HR Director

E-mail: donnie.lebret@dcwmhc.com

Phone: 509-258-4517 ext.767

Applications must be received in the Human Resource Department no later than 4:30 p.m. on the closing date.

The Spokane Tribe reserves the right to hire according to its Indian Preference Policy

All Applicants are subject to a Pre-Employment Drug Test

All Positions with the Spokane tribe of Indians are subject to a 90-day orientation period

Salary : $25 - $35