Billing SpecialistLummi Indian Business Council
JOB SUMMARY: The primary purpose of this position is to submit all billable visits within RPMS. Peer Support is a new service that is available through Lummi Behavioral Health Department that is now a billable service. This position will be additional support for billing all additional services and to provide additional accounts receivable support within the department to work any claims denied to recuperate any funds that are potentially payable if resubmitted. This position will report directly to the Contract & Reimbursement (C & R) Supervisor.
ESSENTIAL JOB DUTIES AND RESPONSIBILITIES include the following, and other related duties as assigned.
- Reviews and completes any insurance claims for Medicaid, Medicare and private health insurances assigned by the Contracting & Reimbursement Supervisor.
- Responsible for billing all charges generated by our peer support staff in coordination with our Lummi Mental Health Services.
- Reviews all billing guidelines that are established through the DBHR/HCA/insurance payers.
- Completes billing within insurance guidelines to prevent timeliness.
- Communicates with billing staff to ensure correct and timely payments on claims submissions.
- Communicates with supervisor regarding any billing questions regularly.
- Responsible for following Federal and State billing requirements on post-payments reviews, exclusions, denials, and appeals.
- Develops main points of contacts with insurance company to address any questions regarding denials.
- Must navigate through Electronic Health Records (EHR), Resource Patient Management Source (RPMS), and Vista Imaging to review documents to ensure accurate billing.
- Must verify patient insurance information provided within RPMS, cross-reference insurance websites, update patient insurances, make notes of any updates.
- Provides Accounts Receivable Specialist support, as needed.
- Works with supervisor to address any new billing insurance specific guidelines to help improve billing policies & procedures.
- Maintain good working relationship with co-workers and supervisor.
- Participates in webinars, meetings and travel, when requested.
- As other duties assigned.
- High School diploma/GED
- Must have at least two (2) year of experience in medical billing/office setting, OR
One (1) year experience in a medical office setting and one (1) year of educational experience in Medical Billing/Coding/Accounts Receivable.
- One (1) year of RPMS experience or billing software.
- Experience with ICD, CPT, and HCPC coding, preferred.
- Must possess a valid Washington State Driver’s license and meet eligibility requirements for tribal insurance.
- Lummi/Native American/Veteran preference policy applies.
KNOWLEDGE, ABILITIES AND SKILLS:
- Knowledge of ICD, CPT, and HCPCS coding.
- Demonstrate ability to use coding experience to acquire, interpret, and resolve problems within a patient’s account.
- Knowledge of operations, priorities, and goals for the Tribal Assister Program.
- Demonstrate ability to keep current with changes in policies and regulations of eligibility for Direct Care and CHS eligibility.
- Demonstrate understanding of pharmacy, medical, and dental coding requirements to produce a clean claim.
- Knowledge of established procedures, required forms, associated with the various health insurance programs.
- Knowledge of the functions of electronic software programs (EHR, RPMS, Vista Imaging), policies, and organization procedures of the Lummi Tribal Health Center and Behavioral Health.
- Knowledge and ability to use and maintain general office equipment, keyboard, printer, copier, 10-key, and computer.
- Ability to interpret and problem solve based on information derived from system reports.
- Must maintain strict confidentiality at all times.
- HIPAA compliance
- Must pass pre-employment and random drug and alcohol test to be eligible for and maintain employment, as required by the LIBC Drug & Alcohol Free Workplace Policy.
- This position requires regular contact with or control over Indian children and is therefore subject to successful and extensive criminal background check, CAMIS background check.
To obtain a Lummi Indian Business Council (LIBC) application go to: https://www.lummi-nsn.gov/Website.php?PageID=381 or request by e-mail firstname.lastname@example.org For more information contact the HR front desk (360) 312-2023. Submit LIBC application, cover letter, resume & reference letters no later than 4:30 p.m. on the closing date listed above. If listing degrees or certifications include copies. Mailing Address: 2665 Kwina Road, Bellingham, WA 98226. Human Resource Fax number: 360-380-6991.