Prepare and submit billing data for technical and professional, primary, and secondary medical claims to insurance companies. Follow up on unpaid, rejected, or denied claims. Resolve issues to resubmit claims in error. File appeals on denials when necessary. Correct patient insurance information as needed. Generate reports and process request for information. Report problems to appropriate department supervisor.

Routine duties shall include providing quality medical billing related to health care services to individuals eligible for services in accordance with the self-governance compact and funding agreement between the Cherokee Nation and the United States executed under the authority of the Indian Self-Determination and Education Act. Bill and rebill institutional and professional medical claims accurately and timely. Document all conversations and actions related to resolving institutional and professional medical claims issues. Prepare "timeline" appeals and /or provider dispute forms, including requesting medical records. Maintain the privacy of patients and their protected health information (PHI); following HIPAA regulations. Verify patient benefits eligibility and coverage and perform patient account data entry maintenance. Manage denial and insurance follow-up and create appeal letters with the appropriate details of the appeal. Navigate through various systems while on the phone. Respond to correspondence from insurance carriers in a timely manner. Read and interpret insurance explanation of benefits. Contact third-party payers in a timely manner to determine the claim status for institutional and professional medical claims. Interpret NCCI edits regarding diagnosis and procedure coding rules and payer guidelines. Other duties may be assigned.

SUPERVISORY RESPONSIBILITIES

This job has no supervisory responsibilities.

Health Claims Biller I (Non-Certified)

EDUCATIONAL REQUIREMENT

High School diploma or general education degree (GED).

EXPERIENCE REQUIREMENTS.

At least six (6) months of experience in a related field.

Health Claims Biller II (Non-Certified)

EDUCATIONAL REQUIREMENT

High School diploma or general education degree (GED).

EXPERIENCE REQUIREMENTS.

At least two (2) years of experience in a related field.

COMPUTER SKILLS

An individual should have knowledge of Accounting software; Database software; Internet software; Spreadsheet software; and Word Processing software.

CERTIFICATES, LICENSES, REGISTRATION

Must possess a valid driver's license with a driving history verified through a motor vehicle report that meets requirements for Cherokee Nation underwriting rating.

OTHER QUALIFICATIONS

The employee must not be and will not be under sanction by the United States Department of Health and Human Services Office of the Inspector General (OIG) or by the General Services Administration (GSA) or listed on the OIG's Cumulative Sanction Report, or the GSA's List of Excluded Providers, or listed on the OIG's List of Excluded Individuals/Entities (LEIE). Educated on and compliant with HIPAA regulations; maintain strict confidentiality of client information.

PHYSICAL DEMANDS

While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk; climb or balance and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, color vision and ability to adjust focus.

WORK ENVIRONMENT

The noise level in the work environment is usually moderate.