Department: Health Department
Closes: Open Until Filled
The Billing Technician is responsible for the PCC data entry, billing and accounts receivable functions which include posting of payments, adjustments and denials to the account receivable RPMS billing system or Point of Sale (POS) pharmacy system. To perform the job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required.
- Assist the Business Office Manager with the RPMS automated and billing and accounts receivable packages
- Responsible for PCC data entry, verification of data, and claims processing. Identifies errors, omission, duplications of documents and contact the appropriate individual to resolve problems
- Works with patient registration to ensure correct insurance information is collected and updated.
- Responsible for verifying insurance, patient eligibility, and/or setting up insurance
- Verifies accuracy of health claim number, authorized claim amounts and ensure services billed are allowable by appropriate regulations, decisions, directives and other controlling guides
- Searches and abstracts all CPT coding and all other pertinent data from the medical record in order to identify appropriate documentation for patient care and other information necessary for billing
- Responsible for maintenance, problem shooting and upgrading in the 3rd Party Billing, Accounts Receivable, and Payers systems
- Responsible for orientating and training all new Billing Staff, explain requirements, methods and procedures used with compliance
- Responsible for maintenance and control of unbilled claims. The individual will notify supervisor of all claims deemed unbillable along with reason(s) on a daily basis
- Reviews all system generated reports for accuracy on a daily basis, and prepares them for billing, transmits electronic claims and/ or paper claims to third party payers, intermediaries or responsible parties on a daily basis
- Works with payers to have all claims submitted via 831 files or utilize portals as necessary
- Research and follow-up on rejected electronic claims
- Receives and reviews all explanation of benefits and remittance and post to the appropriate account
- Responsible for the posting of all contractual/adjustments related to and in conjunction with posting of payments in accordance with clinic policy
- Audit all documents received for completeness and accuracy, analyze and select guid to determine whether payments are full or partial in accordance with clinic policy and procedure; whether they are timely
- Maintains current documentation and guidelines pertaining to reimbursement activities in appropriate files, bingers, etc. and ensures preparation and distribution of copies to all appropriate disciplines
- Documents all activity performed on patient accounts in the billing system
- Individuals performing pharmacy specific duties will be responsible for running and reviewing rejection reports in the Point of Sale (POS) package
- Individuals performing pharmacy specific duties will be responsible for reviewing and making necessary corrections to claims in the Point of Sale (POS) package
- Responsible for self-education by reading all third part newsletters, periodicals and updates circulate by management. Attend all continuing education opportunities made available
- Responsible for generating weekly and/or monthly statistical billing/A/R reports requested by manager
- Maintain a working knowledge of all applicable Federal, State and Band laws and regulation, as well as all policy and procedures
- Maintain strict patient confidentiality following state and federal laws. Assures HIPPAA compliance with regard to billing practices
- Actively participates in department meetings, committees and conferences
- Back up support for other billers that off work for (3) or more days
- Other duties as assigned by manager
- High school diploma or GED equivalent
- One to three years prior experience with third party billing receivables in a medical clinic setting.
- Thorough understanding of computer system, knowledge of Windows and MS Office, RPMS billing software and other billing packages.
- Knowledge and understanding of established and standardized business office procedures and clinic policies sufficient to handle duties.
- Working knowledge of ICD-10 and CPT/HCPS’ coding terms in order to interpret and resolve problems based on information.
- General knowledge of third party payer reimbursement logic and accounts receivable management.
- Knowledge of a variety of accounting transactions and documents, codes, structures and procedures.
- Exceptional organizational skills.
- Experience with database management.
- Knowledge of patient care charts and patient histories.
- Ability to gather data, compile information and prepare reports.
- Knowledge of HIPPA regulations and the Data Privacy act of 1974 and the ability to maintain strict confidentiality of patient, medical, clinic and Band information
- The employee is frequently required to sit or stand for long periods, walk distances, as wll as stoop, bend, kneel, and crouch.
- Position may require employee to be able to lift to 50 pounds as well as assist patients with their needs.
The Indian Preference Act will be enforced. The above statements are intended to describe the general nature and level of the work being performed by the people assigned to this work. This is not an exhaustive list of all duties and responsibilities associated with it. The Fort Mohave Indian Tribe reserves the right to amend and change responsibilities to meet the business and organizational needs.