Medical Records Biller IV- Lead Jobs

Medical Records Biller IV Lead

Koniag Advisory Business Solutions, LLC, a Koniag Government Services company, is seeking a Medical Records Biller IV Lead to support KABS and our government customer in Oklahoma, OKC. This position requires the candidate to be able to obtain a Public Trust. This position is covered under the Service Contract Act. We offer competitive compensation and an extraordinary benefits package including health, dental and vision insurance, 401K with company matching, paid holidays, paid vacation, paid sick leave and more.

Join Our Team Where Precision, Integrity, and Expertise Matter. Koniag Advisory Business Solutions (KABS) is seeking highly skilled, self-directed Medical Biller IV (Lead) professionals to support a large-scale healthcare mission serving hospitals and clinics. This role is designed for experienced billers who can manage complex claims activity, handle payer escalations, and serve as a technical resource to junior staff. In this role, you will support accurate and timely submission of third-party claims, resolve denials and payer issues, review documentation and coding-related billing data, assist with audits and appeals, and help improve billing quality across the team. This position is well suited for seasoned professionals who combine strong reimbursement knowledge with sound judgment and a proactive, solutions-oriented work style.

Work Schedule and Hybrid Conditions: This is a hybrid position based in Oklahoma City, Oklahoma. We anticipate July 1 as the project kick-off date. During the first few weeks of onboarding and initial training, employees are required to work on site full-time, Monday through Friday, 8:00 a.m. to 5:00 p.m. CT, at 701 Market Dr, Oklahoma City, OK 73114. Core working hours are generally 9:00 a.m. CT to 3:00 p.m. CT, with exact start and end times determined by the Program Manager. Work hours may flex based on client needs. Based on demonstrated proficiency and successful performance in all areas of responsibility, employees may become eligible for telework. Telework is a temporary privilege and may be modified or rescinded at any time due to operational, client, business, or security requirements.

The Medical Biller IV (Lead) performs advanced billing and account-receivable functions for outpatient and inpatient claims and serves as a lead-level individual contributor within the billing team. This role handles complex billing scenarios, supports denial management and appeals, assists with audits and payer reviews, helps refine billing procedures, and provides mentoring and technical guidance to junior staff while maintaining hands-on production responsibilities.

Key Responsibilities Billing Program:

• Oversees preparation and submission of complex outpatient and inpatient claims to third-party payers, intermediaries, and responsible parties in accordance with required timelines and internal controls.
• Reviews daily system reports and monitors claim inventory to ensure timely processing, export, and transmission.
• Responds to post-payment reviews, exclusions, denials, and appeals and assists with medical reviews and claim-level audit activity.
• Ensures daily billing productivity reporting is accurate and that unbillable claims are identified, documented, and elevated appropriately.
• Verifies that electronic billing transmissions are HIPAA compliant and that reconciliation and correction activities are completed promptly.
• Maintains current knowledge of payer guidance, listserv updates, policy changes, and continuing education resources.

Verification Data:

• Performs advanced review of medical records to validate diagnoses, dates of service, provider signatures, attestation requirements, and documentation needed to support claim submission.
• Identifies trends, discrepancies, and documentation issues and coordinates with providers, billing staff, and other departments to resolve problems before claims are transmitted.
• Guides eligibility verification and insurance-identification review activities for complex cases and supports resolution of coverage issues.
• Supports preparation and compilation of authorizations, benefits assignments, release forms, and pre-certification documents needed for payer approval and claim support.
• Refers appropriate patients to Benefits Coordination or Social Services and helps staff navigate complicated eligibility situations.

Claims Process / Accounts Receivable:

• Reviews patient records and billing data for outpatient and inpatient services and supports accurate sequencing of ICD, CPT, and HCPCS codes used in billing.
• Ensures provider documentation supports billed diagnoses, procedures, and E&M levels and resolves discrepancies affecting reimbursement.
• Monitors inpatient daily census and ADT-related issues and coordinates with admitting and utilization review personnel when system or workflow gaps are identified.
• Maintains corrective action information from fiscal intermediaries and payers and shares findings with appropriate staff for reconsideration or appeal.
• Prepares and reviews UB-04, CMS-1500, and other required forms for accuracy, completeness, and regulatory compliance.
• Leads correction of rejected or suspended claims and supports collection activity by maintaining accurate documentation in RPMS or other approved systems.
• Assists in establishing daily billing procedures, status tracking methods, and claim follow-up controls.

Benefits Coordination Function:

• Communicates with DHHS operational personnel, fiscal intermediary staff, claims processing personnel, Social Security Administration, state medical offices, PRO personnel, and Service Unit staff to resolve challenging billing and systems issues.
• Maintains communication with first-line billing leadership to support proper use of funds collected from third-party insurance under applicable Indian Health Care Improvement Act requirements.
• Responds to ad hoc requests by defining information needs, structuring search strategies, and retrieving required data from approved systems.
• Determines when data reconstruction, reruns, or restart actions may be needed to better align systems processing with billing requirements.

Administrative Support:

• Acts as a lead contact for complex claims-processing questions and recurring billing problems and recommends changes in methods or procedures to improve outcomes.
• Maintains confidentiality of Alternate Resources claims and medical records and ensures staff follow disclosure limits under IHS policy.
• Helps prepare responses to inquiries elevated by facility leadership and follows up to ensure timely resolution.
• Mentors new staff and provides technical guidance to Medical Biller III personnel as assigned.

Required Qualifications:

• High school diploma or equivalent plus 5+ years of progressively responsible medical billing, claims processing, patient accounts, or revenue cycle experience; or an associate's or bachelor's degree in Health Information Management, Medical Billing and Coding, Business, or related field with 2+ years of progressively complex experience.
• Completion of an accredited Medical Billing, Medical Coding, Health Information Management, or related program preferred.
• Advanced knowledge of outpatient and inpatient claim preparation, denial management, payer requirements, UB-04 and CMS-1500 billing, and accounts receivable follow-up.
• Strong working knowledge of ICD, CPT, and HCPCS coding as used in billing support functions.
• Experience with audits, appeals, post-payment review response, and payer communication.
• Proficiency with EHRs, RPMS or comparable systems, billing platforms, and reporting tools.
• Strong independent judgment, attention to detail, and analytical capability.

Preferred Qualifications or Experience:

• Experience working in Indian Health Service.
• Expertise in Medicare, Medicaid, and commercial insurance billing requirements and reimbursement practices.
• Ability to mentor new staff and build cohesive working relationships with team members.
• Familiarity with HIPAA regulations and healthcare compliance.
• Possess sufficient initiative, interpersonal relationship skills, and social sensitivity such that he/she can relate constructively to Native American communities.

Security and Compliance Requirements:

• You must be able to obtain and maintain a favorable Tier II background investigation determination, as required by the Indian Health Service (IHS), as a condition of access to IHS facilities, systems, and data. Employment is contingent upon successful completion of all credentialing, fingerprinting, identity proofing, and security processing required by IHS and any other authorized government offices.
• You must also be able to comply with all applicable medical privacy, records confidentiality, and IT security requirements governing access to patient information and federal systems.
• In this role, you must adhere to HIPAA, HITECH, the Privacy Act, and all IHS privacy and security policies and procedures. This includes protecting electronic and paper records, using only authorized systems and approved access methods, maintaining workstation and password security, completing required privacy and IT security training, and immediately reporting any suspected privacy breach, security incident, or unauthorized disclosure.

Compliance Requirements:

• Must be able to obtain and maintain a favorable Tier II background investigation determination, as required by IHS.