Health Claims Biller , II, or III; Non-Certified

Job Summary

Prepare and submit billing data for technical and professional, primary, and secondary medical claims to insurance companies. Follow up on unpaid, rejected, or denied claims. Resolve issues to resubmit claims in error. File appeals on denials when necessary. Correct patient insurance information as needed. Generate reports and process request for information. Report problems to appropriate department supervisor.

• Bill and rebill institutional and professional medical claims accurately and timely.
• Document all conversations and actions related to resolving institutional and professional medical claims issues.
• Prepare timeline appeals and provider dispute forms, including requesting medical records.
• Maintain privacy of patients and their protected health information (PHI) following HIPAA regulations.
• Verify patient benefits eligibility and coverage and perform patient account data entry maintenance.
• Manage denial and insurance follow-up and create appeal letters with the appropriate details of the appeal.
• Navigate through various systems while on the phone and respond to correspondence from insurance carriers in a timely manner.
• Read and interpret insurance explanation of benefits and contact third-party payers to determine claim status for institutional and professional medical claims.
• Interpret NCCI edits regarding diagnosis and procedure coding rules and payer guidelines.

This job has no supervisory responsibilities.

• Educational Requirement: High School diploma or general education degree (GED).
• Experience Requirements: At least six (6) months of experience in a related field.
• Computer
  
  Skills:
  
  Knowledge of Accounting software;
  Database software;
  Internet software;
  Spreadsheet software; and Word Processing software.
• Certificates, Licenses, Registration: Must possess a valid driver’s license with a driving history verified through a motor vehicle report that meets requirements for Cherokee Nation underwriting rating.
• Other
  
  Qualifications:
  
  Not under sanction by the United States Department of Health and Human Services Office of the Inspector General (OIG) or by the General Services Administration (GSA) or listed on the OIG’s Cumulative Sanction Report, or the GSA’s List of Excluded Providers, or listed on the OIG’s List of Excluded Individuals/Entities (LEIE). Educated on and compliant with HIPAA regulations; maintain strict confidentiality of client information.

While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk; climb or balance and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 10 pounds.

Specific vision abilities required by this job include close vision, color vision and ability to adjust focus.

The noise level in the work environment is usually moderate.