Great Plains Tribal Health · 1 month ago
Billing Coordinator I/II/III
Rapid City, SD
Full-time
Onsite
Entry, Mid, Senior Level
$21/hr - $27/hr
1+ years expGreat Plains Tribal Health is a tribal organization focused on providing healthcare services. They are seeking a Billing Coordinator who will handle insurance billing for third-party claims, analyze medical information for accurate submission, and oversee billing coordinators to ensure proper reimbursement.
CommunitiesFitnessHealth Care
No H1B
Responsibilities
Prepare, process and submit clean claims to various insurance claims according to payer guidelines and deadlines either electronically or by paper
Maintain current knowledge and understanding of each insurance payer’s rules, regulations and deadlines and apply this knowledge in daily duties and assignments
Recognize and identify errors and communicate these to insurance payers Billing Coordinator II or III
Monitor and reconcile delinquent accounts
Documented ability to prioritize workload and meet quality and production standards
Effectively communicate with clearinghouse and insurance companies regarding claim status, including rejections, denials, corrections and other various issues
Communicate with coding department regarding coding-related denials needing correction
Provide appropriate third-party account status and any issues to Lead Biller or Business Office Manager
Responsible for daily clearinghouse reconciliation of reports and claims
Answer questions from patients, clerical staff, tribes, subcontractors and insurance companies
Perform various collection actions including contacting by phone, correcting and resubmitting claims to third party payers
Participate in CMS, IHS and private insurers’ educational activities as necessary
Conduct self in accordance with GPTLHB’s employee manual
Maintain strict confidentiality; adhere to all HIPAA guidelines/regulations
Perform other related duties as assigned
Research payer denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment
Independently write professional appeal letters
Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as UW Health policies and procedures
Submit retro-authorizations in accordance with payor requirements in response to authorization denials
Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution
Work different claims management denial lists and aging reports for all insurances
Identify and resolve incorrect denials
Maintain individual provider files to include up-to-date information needed to complete the required governmental and commercial payer credentialing applications
Maintain internal provider grid to ensure all information is accurate and logins are available
Update each provider’s CAQH database file timely according to the schedule published by CMS
Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance
Complete revalidation requests issued by government payers
Complete enrollment applications to add providers to commercial payers, Medicare, and Medicaid
Complete re-enrollment applications for commercial payers, Medicare, and Medicaid
Work closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing
Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
Provides Business Office Manager oversight of all daily activities related to the billing coordinators related to performance management
Check-ins with each billing coordinator to go over any claims or billing issues or concerns
Make sure all claims' lists given to the billing coordinators are completed in a timely manner
Participate in meetings pertaining to billing with the business office manager and pertinent staff
Train all new employees (Accounts Receivable Technicians and Billing Coordinators) in the business office
Qualification
Required
High school diploma or GED and one (1) year of medical billing experience
Participates in Core Connections training and applies GPTLHB Core Connections concepts and practices in their work
Familiarity and/or experience working with American Indian populations and respect for and knowledge of traditional, cultural, and spiritual practices of diverse American Indian communities, as well as an ability to work with other culturally and ethnically diverse populations
Proficiency with computer programs (Word, Excel, PowerPoint) and other Internet technologies
Valid driver's license must be kept current, and certificates, credentials or licenses must be kept current and consistent with regulations required by applicable federal, state and/or grant regulations as applies to position
Work in a cooperative and professional manner with OHC and GPTLHB staff
Treat Great Plains tribes and collaborators with dignity and respect
Utilize effective verbal and written communication skills
Advance personal educational development by attending training sessions and seminars as appropriate
Exemplify excellent customer service with tribal stakeholders, health board colleagues, program partners, service recipients, visitors and guests
Foster a work environment of wellness, courtesy, friendliness, helpfulness and respect
Consistently demonstrate respect for and acceptance of differing capabilities, cultures, gender, age, sexual orientation and/or personalities
Maintain and ensure organizational privacy and confidentiality
Promote an alcohol, tobacco and drug-free lifestyle
Complete Billing Certification within one (1) year of employment
Employment is contingent upon the outcome of all required criminal background checks
Compliance with our Employee Health Procedure is a condition of employment. You are required to agree that you will comply with all job-related employee health screening and immunizations prior to your first day of employment. Jobs require that you have documentation that you have completed the following immunizations prior to your first day of employment: MMR (Measles, Mumps and Rubella, Varicella (Chicken Pox), Hepatitis B, Influenza, T-dap (Tetanus - Diphtheria - Pertussis), and COVID-19 vaccination is required
Benefits
Compliance with our Employee Health Procedure is a condition of employment.
You are required to agree that you will comply with all job-related employee health screening and immunizations prior to your first day of employment.
Jobs require that you have documentation that you have completed the following immunizations prior to your first day of employment: MMR (Measles, Mumps and Rubella, Varicella (Chicken Pox), Hepatitis B, Influenza, T-dap (Tetanus - Diphtheria - Pertussis), and COVID-19 vaccination is required.
Company
Great Plains Tribal Health
Great Plains Tribal Leader’s Health Board (GPTLHB) provides key advocacy for its constituents in order for them to have access to the highest quality, most comprehensive, and up-to-date health resources available in the areas of research, education, technical assistance, prevention, and outreach.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Jerilyn Church
President/Chief Executive Officer
Company data provided by crunchbase