Billing Coordinator

BillingCoordinatorfy26 (003).docx

Position Title: Billing Coordinator

Division: Business Office

Reports To: Business Office Manager

Job Summary:

Billing Coordinator handles third-party insurance billing, reviews medical information for accurate claims, collaborates with coders, and addresses denials, errors, and recurring issues to ensure proper reimbursement.

Essential Functions

The following functions are fundamental to the position and are required of all incumbents, with or without reasonable accommodation. These functions define the role and are not an exhaustive list of all duties.

• Prepare, process and submit clean claims to various insurance claims according to payer guidelines and deadlines either electronically or by paper.
• Obtain knowledge on dental billing within the dental billing platform
• Obtain knowledge on pharmacy billing processes
• Obtain knowledge on Honor Every Woman program
• Obtain knowledge on Worker's Compensation/Attorney claims
• Maintain current knowledge and understanding of each insurance payer's rules, regulations and deadlines and apply this knowledge in daily duties and assignments
• Recognize and identify errors and communicate these to insurance payers Billing Coordinator II or III.
• Monitor and reconcile delinquent accounts.
• Documented ability to prioritize workload and meet quality and production standards.
• Effectively communicate with clearinghouse and insurance companies regarding claim status, including rejections, denials, corrections and other various issues.
• Communicate with coding department regarding coding-related denials needing correction.
• Provide appropriate third-party account status and any issues to Lead Biller or Business Office Manager.
• Responsible for daily clearinghouse reconciliation of reports and claims.
• Answer questions from patients, clerical staff, tribes, subcontractors and insurance companies.
• Perform various collection actions including contacting by phone, correcting and resubmitting claims to third party payers.
• Participate in CMS, IHS and private insurers' educational activities as necessary.
• Conduct self in accordance with GPTLHB's employee manual.
• Maintain strict confidentiality; adhere to all HIPAA guidelines/regulations.
• Perform other related duties as assigned.

Education/Experience

Minimum Qualifications:

• High school diploma or GED and one (1) year of medical billing experience.

Preferred Qualifications:

• Experience with RPMS and EHR preferred but not required.
• Excellent verbal and written communication skills with the ability to be detail oriented

Computer and technical skills (including Word, PowerPoint, Excel, Outlook, etc.).

The GPTCHB is a tribal organization that follows tribal preference laws. Our policy is to give preference to qualified Indian/Tribal candidates over a qualified non-native candidate in hiring decisions if all other qualifications are equal.

Employment is contingent upon the outcome of all required criminal background checks.

Compliance with our Employee Health Procedure is a condition of employment. You are required to agree that you will comply with all job-related employee health screening and immunizations prior to your first day of employment. Jobs require that you have documentation that you have completed the following immunizations prior to your first day of employment: MMR (Measles; Mumps and Rubella), Varicella (Chicken Pox), Hepatitis B, Influenza, T-dap (tetanus - Diphtheria - Pertussis), and COVID-19 vaccination is required.

This position requires the ability to perform the essential functions of the job, with or without reasonable accommodation. Physical demands and work environment may include:

• Primarily sedentary work is performed in an office or administrative setting.
• Requires the ability to sit for extended period and regularly use standard office equipment such as a computer, keyboard, telephone, and copier.
• Occasional standing, walking, bending, and reaching may be required.
• Ability to lift and carry office materials or supplies up to 25 pounds occasionally.
• Requires manual dexterity and visual acuity for computer use and document review.
• Must be able to read, write, speak, and hear.
• Work is performed primarily in an indoor office or administrative environment.

The environment involves everyday risks or discomforts that requires normal safety precautions typical of office settings, including proper use of office equipment and awareness of trips, falls, and fire regulations.