This role is for a detail-oriented professional with a passion for healthcare billing and coding. As a key member of the healthcare administration team, you will ensure accurate billing and coding for insurance claims and patient services. The position suits someone with experience in medical terminology and coding systems like ICD-10, CPT, and HCPCS, who is committed to maintaining high standards of accuracy.
Responsibilities
Perform coding reviews on medical records to maintain subject matter expertise
Complete internal audits of all medical coding and charge entries prior to submission for processing
Maintain contact with staff within all departments to obtain additional patient information to document and process billings
Analyze all billing and claims for accuracy and completeness; conduct follow-up and corrective actions on any issues identified
Ensure that the activities of the billing operations are consistent with overall protocols and follow federal, state, and payer regulations, guidelines, and requirements
Keep up to date with all insurance carrier rule changes and distribute the information
Understand and remain updated with current coding and billing regulations and compliance requirements
Maintain a working knowledge of all health information management issues such as HIPAA and all health regulations
Check eligibility and benefit verification of all patients
Contribute to a positive team environment that fosters open communication, sharing of information, continuous improvement, and optimized medical coding results
Aid clients and their families in the application process through the Healthcare Exchange; facilitate completion of applications for subsidies or cost shared options, for Medicaid Program where eligible, or for full premium coverage when over income for Medicaid or subsidized coverage
Educate clients on how to select a health insurance plan
Explain terms and conditions for plans, costs, payment options, and penalties
Instruct patients on how coverage will interact with current access to healthcare through Indian Health Services, Tribal Programs, or Indian Programs
Ensure all patient information is accurate and complete; conduct appropriate entries into the Electronic Health Record system
Create and maintain all documentation regarding patient confidentiality (HIPAA, 42 CFR Part 2, etc.)
Perform other duties as assigned
Adhere to QCH and QWC Policies
Requirements
Two (2) years of experience working in a medical setting
Knowledge and understanding of medical billing, collections and payment posting, revenue cycle, third party payers, Medicare, and strong knowledge of Washington and Federal payer regulations
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Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, transcription, designing forms, and other office procedures and terminology
Knowledge of principles and processes for providing customer and personal services, including customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction
Knowledge and adherence to state (RCW, WAC) and federal confidentiality regulations (42 CFR part 2)
Knowledge of HIPAA and PHI requirements
Knowledge of common office and administrative procedures
Skills in the operation of a personal computer and standard office programs and equipment
Ability to work in a cross-cultural environment and understand the social and cultural context of the patients, understanding the role of trauma, historical, community, family, and personal experience in wellness and recovery
Must pass criminal background investigation and reference inquiry
Nice to have:
Medical Coding Certification
Benefits
Medical, Prescription, Vision and Dental for full-time employees (100% of premiums covered for employee-only plan, option to add dependents at additional cost)
100% of premiums covered for full-time employees for both short-term and long-term disability plans
Gracious employee leave program including 14 holidays, paid annual leave and paid sick leave
100% reimbursement for costs of required licenses and certifications
Important Details
Physical requirements: Regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. Required to work at a computer workstation during scheduled shift. Required to have in-person interaction with patients. Occasionally required to stand; and stoop, kneel, crouch, or crawl.
Schedule: Employees must be able to report to work on time and work their full scheduled shift.
About the Company
Quinault Community Health is located on the Olympic Peninsula, surrounded by city, county, state, and federal parks, offering many outdoor activities including hiking, camping, hunting, fishing, ocean beaches, lakes, rivers, and bird watching.
