Billing Technician

SUMMARY Responsible for preparing, submitting, reviewing, and correcting third-party healthcare claims to support accurate reimbursement for services provided by the Health Center. This position reviews electronic health records and billing documentation, follows payer requirements, assists with claim denials and rejections, and maintains accurate billing records while protecting confidential patient information. ESSENTIAL DUTIES And/or RESPONSIBILITIES Include The Following Prepare, review, and submit third-party claims to Medicare, Medicaid, and private insurance payers. Review electronic health records and supporting documentation to ensure claims contain accurate and complete information. Utilize the Resource and Patient Management System (RPMS), electronic health records, and billing software to process claims. Apply knowledge of medical terminology and ICD-10-CM, CPT, and HCPCS coding references to support accurate claim submission. Review Remittance Advices (RAs) and Explanation of Benefits (EOBs) to identify payments, denials, rejections, and claim discrepancies. Research and address claim denials and rejections promptly, including submitting corrected claims and required documentation. Process crossover claims and assist with claim resubmissions and follow-up. Maintain knowledge of payer billing requirements, eligibility guidelines, and reimbursement policies. Communicate with insurance companies, providers, and appropriate staff to resolve billing issues. Maintain accurate billing records and protect confidential patient and financial information in accordance with applicable laws and organizational policies. Other duties may be assigned. QUALIFICATION REQUIREMENTS To perform this job successfully, an individual must be able to perform each duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the duties. EDUCATION And/or EXPERIENCE Associate's Degree in Business or an equivalent of two (2) years' experience working in an office or healthcare setting. Healthcare billing, claims processing, or medical coding experience preferred. Certified professional biller (CPB) and/or professional coder (CPC) preferred. KNOWLEDGE, SKILLS, And/or ABILITIES Knowledge of third-party billing procedures and claims processing for Medicare, Medicaid, and private insurance. Familiarity with medical terminology and ICD-10-CM, CPT, and HCPCS coding Ability to review billing documentation, identify discrepancies, and assist with claim Ability to communicate effectively with insurance representatives, healthcare providers, and staff. Working knowledge of Microsoft Word, Excel, and electronic billing systems. Ability to maintain confidentiality and safeguard patient information in accordance with applicable privacy requirements, including HIPAA. PLEASE NOTE: P.L. 93-638, Indian Preference and Tribal Employment rights Ordinance. (T.E.R.O) will be practiced; however, all qualified applicants will be considered. #J-18808-Ljbffr