Hours Per Week: 40

Job Type: Full-time, Non-Exempt

Summary/Objectives of Position

The Certified Biller & Coder Specialist's responsibility is to ensure the smooth facilitation of communication with funding sources, program partners, and insurance companies. This position will spend most of the time interpreting patient files and using established systems that make it easy for insurers to recognize the type of treatment covered under a patient’s plan. The day-to-day work of the Certified Biller & Coder Specialist includes proper coding of services, procedures, diagnoses, and treatments. Preparing and sending invoices or claims for payment. It is the responsibility of the position to gather documentation to validate the coding choices and argue against any wrongfully denied claims. They analyze all parts of a patient’s visit, including diagnostic tests, consultations, in-office procedures, and prescribed medication.

Essential Duties, Functions & Responsibilities

• Works with the Finance area in overseeing the operations of the billing area, which encompasses medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management.
• Responsible for ensuring that codes are assigned correctly and sequenced appropriately as per government, program, and insurance regulations.
• Ensures compliance with medical and behavioral health coding guidelines and policies.
• Responsible for receiving and reviewing patients’ health records and documents, verifying for accuracy.
• Following up and clarifying any information that is not clear to providers and other staff members.
• Collect information provided by the provider from different sources to prepare monthly reports and support BAIHP tracking and utilization reporting. Compiles accurate statistical reports.
• Responsible for working with management in the implementation of strategic procedures and choosing strategies and evaluation methods that provide correct results.
• Responsible for the translation of healthcare services, procedures, diagnoses, and treatments into standardized codes using systems like CPT, HCPCS, ICD-10-CM, and ASA.
• Regularly prepares and submits claims to funding agencies and insurance companies or other payers.
• Responsible for the review and correction of rejected claims.
• Responsible for the preparation and invoicing to patients, and working with them to create payment plans.
• Responsible for tracking and collecting payments and posting to patient accounts.
• Ensures regular follow-up with patients and insurance companies regarding outstanding bills and claims.
• Responsible for ensuring that denied claims and corrected and resubmitted in a timely fashion, usually within 24 hours.
• Supports effective systems and processes regarding billing by conducting regular audits and reviews of claims for services rendered.
• Works with the Medical Director in examining any medical malpractice issue reported by analyzing and identifying the medical procedures, diagnoses, or events that lead to negligence.

Minimum Mandatory Qualifications

Education:

• High School diploma/ GED required.
• Completion of billing/coding certificate or diploma.
• Bachelor's degree in healthcare administration, health information management, or related field preferred.

Experience:

• Minimum 2 years of reimbursement/collections experience.
• Experience with medical coding guidelines and procedures such as ICD-9, CPT, ARG, and ASA, among several others.
• Experience as a medical coder/biller with a working knowledge of managed care, Kaiser, Anthem, VA, ODS, commercial insurance, Medicare, and Medicaid reimbursement.

License/Certification:

• Valid CA driver’s license is required.
• Billing & Coding Certification (AAPC, NHA, or other recognized certification program)

Skills:

• Strong attention to detail and accuracy in data entry.
• Mathematical proficiency.
• Strong organizational skills.
• Knowledge and understanding of data entry and transcription.
• Basic to intermediate understanding of medical terminology.

Communication Skills:

• Demonstrates proficiency in communication and writing skills.
• Language Skills: Ability to read, analyze, and interpret general and professional documents.
• Ability to write routine reports and correspondence.

Interpersonal Skills:

• Ability to foster teamwork; train and direct the work of team members and colleagues.
• Excellent organizational skills, including the ability to work productively and make independent decisions.

Technology

• Knowledge of automated billing systems and CMS HCFA 1500 form.
• Familiar with electronic healthcare records systems.
• Proficiency with using computer-based applications (e.g. Microsoft Office) and clinical information management systems.

Benefits Offered at BAIHP:

At BAIHP, we value our employees and strive to provide comprehensive benefits to support their well-being, financial security, and work-life balance. Here's what we offer:

• 401(k) matching
• Dental, Health, & Vision insurance
• Health savings account
• Life insurance
• Paid time off (Vacation, Sick, Vacation Reward)
• Employee Assistance Program (EAP)

Indian Preference

BAIHP complies with the Indian Preference Act. Preference in hiring is given to qualified Native Americans under the Indian Preference Act (Title 25, US Code, Sections 472 and 473). Subject to, but not in derivation of the Act, we are an equal opportunity employer.