Medical Biller/Staff Accountant

MEDICAL BILLER / STAFF ACCOUNTANT
Department: Business Operations Department
FLSA Status: Full Time/Hourly
Wage Range: $28.00/hr. - $35.00/hr./ DOQ/DOE
Work Schedule: Monday through Friday, Days/ On-site.
Revised Date: 05/2023
Employee Benefits
• Full Medical, Dental and Vision benefits after 60 days employment (30 days for active Licensed or Certified Healthcare Professionals).
o HL7N pays 100% of the insurance premium for Full-time Employees (32 hours+).
o HL7N pays 100% of the Employees $5,000 deduction utilizing the Difference Debit Card
o HL7N pays 100% of the Employees Dental and Vision expenses up to $1,000 utilizing the Difference Debit Card.
• $75,000 Life Insurance, Short and Long-Term disability after 90 days. HL7N pays 100% of the Life Insurance premium for Full-time Employees (32 hrs.+)
• Annually Employees receive 12 paid holidays; 20 Paid-Time-Off (PTO) days per year after the employee has been employed FTE (32 hrs.+) and achieve successful 90-days performance evaluation rating.
• 403(b) Thrift Savings Plan with the HL7N maximum pension contribution of 4%, completed 12 months of employment (2,080 hrs.) and successful performance evaluation rating.
• Healing Lodge employment may qualify for the federal Public Service Loan Forgiveness (PSLF) program as well as loan repayment through Health Resources and Services Administration (HRSA)
About the Company
The Healing Lodge of the Seven Nations (HL7N) is a progressive, expanding and developing inpatient treatment center and outpatient comprehensive behavioral health clinic residing on 51 wooded acres with an inpatient 45-bed capacity for youth (13 to 17 years of age; female & male). The HL7N integrates traditional, spiritual, and cultural values combined with substance use disorder and mental health counseling services to create a supportive and holistic approach towards adolescent healing.
The Healing Lodge is seeking a dedicated and professional candidate who is interested in a long-term career with growth opportunities. COVID vaccinations and Boosters are required for 24/7 youth residential treatment center environment with up to 80 employee healthcare professionals and support staff.
Duties and responsibilities
1. Process and review insurance claims, EOBs, claim denials; posts payments; works account for collections; verifies EHR/Billing reports for accuracy; provides information to insurance carriers, and prepares charge reports for payors.
2. Monitor/reconcile aging reports and take necessary steps to guarantee timely payment of aging claims avoiding denied due to late submittals. Review denials or partially paid claims and work with the payors to resolve the discrepancy.
3. Gathers information on each through a medical records review, notes, invoices, etc., and prepares appeals summaries.
4.. Review electronic claims to ensure timely payment, correct denied claims in response to error messages and submits additional information requested.
5.. Responsible for all back-end e-claim including reimbursement verification, dispute resolution process payment agreements.
6. Responsible for charges, including the release of order entry, using correct CPT and ICD-10 codes, and being knowledgeable of current coding rules and regulation.
7. Communicate with health care providers, patients, insurance claim representatives, and other parties to clarify billing issues and facilitate timely payment.
8. Consult supervisor, team members, and appropriate resources to solve billing and collection questions and issues.
9. Provide high quality work performance meeting industry and agency standards, policies, and procedures; escalate compliance and billing issues to supervisor.
10. Work, in conjunction with the Admissions Office on all new Residents for entering individuals into the medical billing system, by verification of health care payer coverage and prior authorizations for continuation of inpatient and outpatient services, as required by payors.
11. Develops positive and collaborative working relationships with organization personnel & client benefit agents (govt, tribal, private payors) and works collaborative with agency medical billing consultant on accounting for services, processing of billable claims and corrections of errors and omissions.
12. Maintain current in HIPPA regulations and patient confidentiality.
13. Maintain current on changes in government and healthcare insurance carrier regulations in healthcare claims processing regulations.
14. Provide staff training on patient service entry errors and omissions to reduce claim denials by payors and avoiding delays in payments.
15. Provide fiscal administrative analysis and support for the Business Operations Department, Finance Department, and Executive Director.
16. Performs special projects and other tasks as assigned
Position Requirements
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are also representative of the knowledge, skill, and ability required to demonstrate ability to perform the job duties outlined.
Supervisory Responsibilities:
The Medical Biller Account Representative supervises the Medical Billing office and personnel/temps in the absence of the Medical Billing Manager.
Work Experience:
1. Minimum of three years or greater progressive advanced work experience in medical billing demonstrating proficiency in revenue cycle management.
2. Possess progressively advance experience in application of CPT and ICD 10 codes
3. Possess strong productivity skillsets, advanced solution focused knowledge and skills, thrive in fast pace work environments, comfortable in partnering in cohort projects and working in a team working environment.
4. Comfortable with formal presentations, performing tasks at all levels, meeting deadlines, and ability to successfully lead and coach clinical staff in completing medical billing claims properly.
Education
1. Possess an associate degree from accredited college in healthcare, accounting, or related field.
Training / Certification:
1. Possess coding system training in outpatient medical, mental health, substance abuse and SUD residential inpatient treatment.
2. Possess education and/or training in the utilization of Electronic Health Records (EHR) and
E-Medical Billing Software apps.
Certificates, License or Registrations
1. Possess certification from American Academy of Professional Coders (AAPC) or Healthcare Common Procedure Coding System (HCPCS) preferred.
2. Possess medical biller certification from accredited training institution.
Knowledge and Skills Required:
1. Possess accounting knowledge, skill and ability to work independently demonstrating good judgement, high accuracy in filing and processing of medical billing, troubleshooting e-medical billing e-system and EHR software apps.
ADDITIONAL QUALIFICATIONS
Computer Skills:
• To perform this job successfully, an individual must be proficient in Electronic Health/Medical Records system; E-Medical Billing system, MS Office Suite, including Outlook, Word, Excel, & PowerPoint.
Physical Demands:
• The physical demands described here are representative of those that must be met by an employee to successfully the essential functions of this job. While performing the duties of this Job, the employee is regularly required to talk and hear; use hands to finger, handle, or feel; reach with hands and arms; sit for extended amount of time, work using a computer keyboard, stand, and walk; and lift up to 10 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus.
Work Environment:
• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Work is generally performed in an indoor office and/or patient care environment. The noise level in the work environment is generally moderate; normal-level conversation occurring frequently.
Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. The Healing Lodge believes that each employee makes a significant contribution to our success. That contribution should not be limited by the assigned responsibilities. This position description is designed to outline primary duties, qualifications and job scope, but not limit our employees nor the organization to just the work identified. It is our expectation that each employee will offer his/her services wherever and whenever necessary to ensure the success of the company.
Healing Lodge of The Seven Nations is an EEO employer - M/F/Vets/Disabled