3rd Party Billing Specialist

Job Summary The Billing Specialist is responsible for maximizing third-party billing revenue by identifying and utilizing all available payment resources for Medicare, Medicaid, HMOs, insurance, etc. This role ensures accurate and timely revenue processes through daily entry of charges, payments and write-offs. The Billing Specialist collaborates with clinical, registration, coding, and finance teams to resolve billing issues, streamline workflows, and reduce claim rejections and denials. Duties A. Administer third-party billing programs for medical, behavioral health, and dental clinic, ensuring timely submission of claims and payments. B. Advocate on behalf of the Chehalis Tribe in the collection of alternative resources to maximize revenue. C. Accurately post payments, adjustments, and write-offs; respond promptly to third-party payors and patient inquiries. D. Investigate and resolve claim denials, obtain prior authorizations, and reprocess claims to ensure appropriate reimbursement. E. Manage and work Electronic Health Records (EHR) work queues daily, including, but not limited to, Charge Review, Claim Edits, Adjustment Review, Retro Review, Router Review, Router Error pools and any guarantor related and follow up queues. F. Conduct routine follow up on outstanding claims and denials by regularly contacting third-party payors and patients to ensure resolution. G. Perform regular audits to maintain compliance, accuracy, and accountability for all submitted claims. H. Prepare and submit billing and financial reports as requested by leadership. I. Collaborate with clinical staff to identify and resolve gaps in billing processes to improve efficiency and accuracy. J. Participate in tribal compliance and operations workgroup to stay informed on best practices, regulatory changes, and compliance guidelines. K. May be required to remain on-site during emergencies, as needed, to ensure continuity of critical billing and coding functions.

Education & Experience Requirements:

High School diploma or GED and a minimum of three (3) years of experience with third-party billing using current billing standards (ICD-10 codes) required. At least two (2) years of experience working with EHR. Experience with EPIC preferred. Certificate in billing is required. Prefer experience working with American Indian/Alaska Native communities.

Pay:

$27.67 - $38.75 per hour

Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Health insurance Life insurance Paid time off Vision insurance

Education:

High school or equivalent (Required)

Experience:

Medical Billing:

3 years (Required) working with Electronic Health Records (EHR): 2 years (Required)

License/Certification:

Medical Billing Certification (Required) Ability to

Commute:

Oakville, WA 98568 (Required)

Work Location:

In person 3rd Party Billing Specialist 4.8 4.8 out of 5 stars 21 Niederman Rd, Oakville, WA 98568 $27.67 - $38.75 an hour - Full-time Confederated Tribes of the Chehalis Reservation 4 reviews $27.67 - $38.75 an hour - Full-time Job Summary The Billing Specialist is responsible for maximizing third-party billing revenue by identifying and utilizing all available payment resources for Medicare, Medicaid, HMOs, insurance, etc. This role ensures accurate and timely revenue processes through daily entry of charges, payments and write-offs. The Billing Specialist collaborates with clinical, registration, coding, and finance teams to resolve billing issues, streamline workflows, and reduce claim rejections and denials. Duties A. Administer third-party billing programs for medical, behavioral health, and dental clinic, ensuring timely submission of claims and payments. B. Advocate on behalf of the Chehalis Tribe in the collection of alternative resources to maximize revenue. C. Accurately post payments, adjustments, and write-offs; respond promptly to third-party payors and patient inquiries. D. Investigate and resolve claim denials, obtain prior authorizations, and reprocess claims to ensure appropriate reimbursement. E. Manage and work Electronic Health Records (EHR) work queues daily, including, but not limited to, Charge Review, Claim Edits, Adjustment Review, Retro Review, Router Review, Router Error pools and any guarantor related and follow up queues. F. Conduct routine follow up on outstanding claims and denials by regularly contacting third-party payors and patients to ensure resolution. G. Perform regular audits to maintain compliance, accuracy, and accountability for all submitted claims. H. Prepare and submit billing and financial reports as requested by leadership. I. Collaborate with clinical staff to identify and resolve gaps in billing processes to improve efficiency and accuracy. J. Participate in tribal compliance and operations workgroup to stay informed on best practices, regulatory changes, and compliance guidelines. K. May be required to remain on-site during emergencies, as needed, to ensure continuity of critical billing and coding functions.

Education & Experience Requirements:

High School diploma or GED and a minimum of three (3) years of experience with third-party billing using current billing standards (ICD-10 codes) required. At least two (2) years of experience working with EHR. Experience with EPIC preferred. Certificate in billing is required. Prefer experience working with American Indian/Alaska Native communities.

Pay:

$27.67 - $38.75 per hour

Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Health insurance Life insurance Paid time off Vision insurance

Education:

High school or equivalent (Required)

Experience:

Medical Billing:

3 years (Required) working with Electronic Health Records (EHR): 2 years (Required)

License/Certification:

Medical Billing Certification (Required) Ability to

Commute:

Oakville, WA 98568 (Required)

Work Location:

In person