Billing Specialist Hybrid

Billing Specialist II - Hybrid

Klamath Tribal Health & Family Services (KTHFS) is a tribally-operated health facility offering direct medical, dental, pharmacy, behavioral health, and non-emergent transportation services to Native Americans and Alaska Natives residing within the service delivery area. The Billing Specialist is responsible for managing patient accounts in a complex, multi-disciplinary Business Office environment. The incumbent shall cross-train with other members of the Klamath Tribal Health Business Office Staff and shall participate in all functions of the coding and billing cycle, to include: daily review of encounters, analyzing chart notes and assuring the appropriate service codes are utilized, data entry of encounter forms, posting charges into the computer system, perform claims review, claims submission, timely billing, follow-up and collection of all accounts, payment posting, claims audit and research. The incumbent shall also function as a resource for clinic providers and staff and will assist with coding and billing questions, and quality assurance activities.

MAJOR DUTIES AND RESPONSIBILITIES

• Daily review, analyze, and interpret patient ambulatory EHR and/or paper encounter coding and corresponding chart note documentation and determine that the appropriate diagnostic and procedural codes are used and appropriately reflected in the chart note for code assignment as outlined by the CMS guidelines. Assuring that medical/dental necessity billing guidelines are met.
• Ensure the appropriate service codes are applied in the billing record that corresponds to the documentation referenced in the chart note or on the encounter forms. Ensure that the appropriate ICD-10, CPT, HCPCS, CDT coding conventions have been used for services provided by all health service types within KTHFS, including but not limited to: medical, dental, behavioral health and transportation.
• Work with providers and nursing staff to clarify documentation in the EHR system if needed. Including correlating anatomical and physiological processes of a diagnosis to assure the most accurate ICD-10 code(s) are used. Advise supervisor and clinicians of deficiencies to support charge capture of all billable services.

KNOWLEDGE, SKILLS, ABILITIES

• Technical knowledge, skill, and understanding of the American Medical Association developed CPT coding system in order to acquire, interpret, and resolve problems based on information derived from system monitoring reports to be carried over to the required billing forms.
• Technical knowledge, skill, and understanding of the concepts of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for classification of diseases and/or procedures.
• Knowledge and understanding of CDT dental coding system.

Requirements QUALIFICATIONS, EXPERIENCE, EDUCATION

• REQUIRED Onsite training/working for the first year upon hire may be required. Up to 80% of remote work after training requirements are completed subject to business needs and management approval.
• REQUIRED to possess a High School Diploma or Equivalent. (Must submit copy of diploma or transcripts with application.)
• REQUIRED Must have one of the following certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Medical Coder (RMC), RHIA, RHIT or an Associate’s degree in Medical Office Systems or Health Information Management.
• REQUIRED One (1) year of medical and/or dental billing and coding experience. Experience must be reflected on application; or submit copy of coder certification with application

Indian Preference: Indian and Tribal Preference will apply, as per policy. (Must submit tribal documentation with application to qualify for Indian Preference).

ACKNOWLEDGEMENT This position description is intended to provide an overview of the requirements of the position. It is not necessarily inclusive and the job may require other essential and/or non-essential functions, tasks, duties, or responsibilities not listed herein. Management reserves the sole right to add, modify, or exclude any essential or non-essential requirement at any time with or without notice. Nothing in this job description, or by the completion of any requirement of the job by the employee, is intended to create a contract of employment of any type.

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