Billing Specialist, Claims Processing

Full-Time, Regular

Administrative

Anchorage, AK, US

 

 

 

COOK INLET TRIBAL COUNCIL, INC.

JOB DESCRIPTION

 

Job Title: Billing Specialist, Claims Processing

Department: Accounting

Reports To: Billing Manager

Supervises: None

FLSA Status: Non-Exempt

Pay Grade: N5

Job Type: Regular, Full-Time

 

General Functions:

The Claims Processing Billing Specialist, under routine supervision, performs all duties related to preparing and submitting medical insurance claims. This position reviews and adjusts accounts to ensure appropriate claim billing, including interacting with third parties and participants, processes, research, corrects accounts, posts payments and adjustments, and interprets Explanation of Benefits (EOB) documentation.

 

Duties and Responsibilities:

• Submit claims and invoices for payment or reimbursement from third-party payers.
• Submit invoices to participants for payment.
• Assist participants with applications for Medicaid, Food Stamps, Permanent Fund, and any other applicable payment               sources.
• Maintain current coverage status information for participants.
• Resolve insurance denials, Medicaid adjustments, prior authorization issues, clinical records requests, and claims                   resubmission.
• Communicate with appropriate personnel to discuss and resolve discrepancies and complaints.
• Attend training regarding Medicaid billing, regulations, HCPC, and ICD-10 codes.
• Act as liaison between CITC and clients regarding treatment billing.
• Assist in sending past due accounts to collections.
• Monitor and manage aging reports and act to guarantee payment of claims. 
• Conduct billing audits of all notes billable and non-billable notes to ensure billing accuracy.
• Obtain and process in-coming payments and treatment coding to the appropriate grant accounts.
• Responsible for reviewing participant account records and third-party payer issues.
• Monitor payor claim acceptance and response timeliness. 
• Contact payors when needed to obtain claim payment updates. 
• Correct and resubmit claim denials. 
• Escalate claims for potentially payor relations bulk resolution. 
• Ensure proper charge capture, billing, and adjudication of claims per federal, state, and private billing guidelines. 
• Identify, analyze, and reconcile billing errors or omissions. 
• Monitor unbilled accounts to determine actions required to minimize the volume and value of held accounts.
• Review and approve payer refund requests.
• Analyze and escalate payor claim issues for resolution.
• Identify and implement internal billing and collection processes, procedures, and guideline efficiencies.
• Obtain, process, and post all in-coming payments.
• Provide accurate Accounting coding for billing activity.
• Provide information to participants regarding billing accounts.
• Resolve client and staff questions concerning billing statements or account information.
• Work with staff and clients to ensure financial cost agreements are completed.
• Provide support to data collection efforts when needed. 
• Participate in scheduled meetings and training.
• Maintain confidentiality according to regulations, policies, and procedures.
• Perform all other related duties as needed and assigned.

 

Job Specifications: 

• Excellent organizational and time management skills.
• Demonstrated familiarity with standard concepts, practices, and procedures in healthcare. 
• Demonstrated ability to work in a team environment and independently with minimal supervision.
• Highly motivated, self-starter.
• Excellent verbal and written communication skills.
• Strong problem-solving and analytical skills.
• Proficient with PCs and standard office equipment.
• Demonstrated ability to prioritize workload to meet deadlines and fulfill all responsibilities related to this position.
• Ability to work in a collaborative environment with joint responsibilities.
• Excellent attention to accuracy, details, and fact reporting.

 

Minimum Core Competencies: CITC Values, Professionalism, Emotional Intelligence, Problem Solving/Critical Thinking, Communication Skills

 

Minimum Qualifications:

• High School Diploma or GED.
• Two years of experience in medical claims processing or billing.

 

Preferred qualifications:

• Experience in billing and claims processing tribal facility rates.

 

 

NATIVE PREFERENCE STATEMENT: Under the Indian Self-Determination and Education Assistance Act of 1975 (PL 93-638) and as further guided by CITC’s Native Preference Policy 6.120, CITC maintains preference in all phases of employment for Alaska Native, American Indian (AN/AI), and Native Hawaiian people, including direct lineal descendants and foster or traditionally adopted children. Also included are non-Native head of household members for Native families, including foster or traditionally adopted Native children.

 

 

Disclaimer

The information provided in this description has been designed to indicate the general nature and level of work performed by incumbents within this job.   It is not designed to be interpreted as a comprehensive inventory of all duties, responsibilities, qualifications and working conditions required of employees assigned to this job.   Management has sole discretion to add or modify duties of the job and to designate other functions as essential at any time.  This job description is not an employment agreement or contract.