Medical Billing Specialist

The Medical Billing Specialist supports the medical billing for Chugachmiut’s medical, dental, behavioral health, and pharmacy services by performing complex clerical billing functions and maintaining accurate financial records for optimal reimbursement.

• Prepares, reviews, and submits claims to clearinghouse using billing software for reimbursement. This includes processing electronic and paper claims to Medicaid, Medicare, commercial insurance, worker’s compensation, and grant-funded sources for all primary, secondary, and tertiary claims.
• Works directly with the payers, healthcare providers, patients, and billing team to ensure claims are processed and paid promptly by following medical billing guidelines and meeting proper billing standards.
• Answers all patient, insurance, and staff inquiries about assigned accounts.
• Works closely with the health administrative assistants to ensure that insurance data is correct and assists with any billing inquiries.
• Verifies insurance coverage for eligibility and benefits and obtains necessary documentation for reimbursement.
• Prepares, processes, and monitors all prior authorization for service coverage.
• Enters charges accurately and expeditiously to ensure proper records handling and fast payment responses.
• Prepares and posts payments and adjustments to accounts promptly.
• Reconciles payments and adjustments, ensuring posted batches match Remittance Advices.
• Generates adjustments and appeals.
• Research and appeal denied claims when necessary and report payment discrepancies to the manager.
• Identifies and prepares refunds timely and for review by the manager.
• Scans batches, prepare for manager’s review within the established timeframe and ensures workflow spreadsheet is maintained and updated.
• Prepares and monitors all patient statements.
• Monitors account receivables and follows up on unpaid claims within standard billing cycle timeframes.
• Works with patients to coordinate financial solutions, including developing self-pay arrangements and payment plans.
• Maintains billing records according to medical record retention laws.
• Screens patients and clients for insurance eligibility and assists individuals with completing applications for Medicare, Medicaid, and Tricare.
• Represents Chugachmiut positively and respectfully, assisting in promoting and maintaining good public relations among staff, community groups, and professional organizations.
• Conforms to safety policies and general housekeeping practices.
• Demonstrates sound work ethics and flexibility and shows dedication to the position.
• Demonstrates a positive attitude, is respectful, and possesses cultural awareness and sensitivity toward patients, co-workers, and others.
• Keeps customer service and the organization’s mission in mind when interacting with all patients, co-workers, and others.
• Prepared to start shift on time, meet attendance standards, and work the hours necessary to perform the job’s essential functions.
• Embraces, supports, and promotes the core values of respect, integrity, trust, compassion, and quality, which align with Chugachmiut’s Mission and Vision through their actions. and interactions with all patients, staff, and others.
• Conforms to Chugachmiut policies, strict employee confidentiality, HIPAA, and 42 CFR Part 2 regulations.
• Performs other duties as assigned or required.

• High school diploma or GED equivalent.
• Non-supervisory-Three (3) years’ experience in medical billing, education, and/or training may be substituted for experience.
• Two (2) years experience with electronic health system applications, Cerner, nThrive, and Eaglesoft experience preferred.
• Experience working in an Alaska Native Tribal Health billing environment is preferred.

  Knowledge, Abilities, and Skills:

• Knowledge of medical billing, accounting procedures, and applications.
• Knowledge of the 1974 Privacy Act, HIPAA, and 42 CFR Part 2 is required as the use of patient records is an integral part of the position, and the privacy of individuals must be protected to the fullest.
• Knowledge and experience of commercial insurance and government reimbursement programs.
• Knowledge and experience of medical terminology, abbreviations, and clinical systems.
• Knowledge of computer operations, standard office equipment, typing, filing, scanning, and utilization of online portals.
• Skill in understanding medical billing procedures and protocols.
• Skills working in a fast-paced environment, ability to multitask and prioritize job duties and projects.
• Skill in organization, problem-solving, priority setting, and deadline accomplishment.
• Ability to recognize and identify overpayments.
• Ability to perform the job with minimum supervision.
• Ability to establish and maintain effective working relationships with patients, employees, and the public and have the desires and dedication to work.
• Ability to communicate effectively and practice meaningful customer service skills addressing patient and staff needs courteously and promptly, both orally and in writing.
• Ability to continuously increase productivity and is highly motivated, effectively performing with minimal supervision.
• Ability to provide administrative support in a timely and efficient manner.