Position: Medical Claims Biller /Collections Specialist (Regular, Full-time)

Program:  Wind River Family and Community Health Care

Salary:  Negotiable 

Opening Date:  August 12, 2019

Closing Date:  Open Until Filled

Hours:            Monday-Friday, 8:00am-4:45 pm


Wind River Family & Community Health Care provides ambulatory health care for the service population of the Wind River Reservation. The Medical Biller/Collector serves as a member of the administrative staff of the ambulatory health care clinic located in Arapahoe, Wyoming.

The incumbent is responsible for accurate and timely processing of claims generated and batched daily and then electronically uploaded to various insurance companies and third-party payers.  Prepare and submit insurance claims to all third-party payers for all patients who receive care from Wind River Family & Community HealthCare facilities. Review patient health information in the RPMS system to determine billable charges.  Reviews all claims prior to submitting them electronically to various payers. Maintains a file system for billed claims for audit purposes. Monitors the accounts receivable for assigned payers and works denied and rejected claims daily and maintains a file system for denied and rejected claims to follow up on daily until these claims are paid.  Interacts with other departments at Wind River Family and Community Healthcare and outside agencies.       

Job Duties:

  1. Process and manage the filing of medical billing claims for a variety of health-related services (i.e. Medical, Dental, Behavioral Health, Chemical Dependency, Optometry, Pharmacy, Radiology, etc.) 
  2. Process billing claims with health carriers to include, Medicare, and Medicaid, patient private insurance carriers, railroad, self-insured agencies, government agencies, etc.
  3. Ensure timely billing of all health-related health care service claims avoiding any delays in filing and correct any errors quickly to insure payment and/or to avoid non-payment.  
  4. Process medical claims daily utilizing carrier claim forms or electronic claim filing sources, accurately and in a timely manner.  
  5. Review daily status of accounts receivable to identify and resolve billing and processing problems.  
  6. Ensures insurance payments are in alignment with fee schedules.
  7. Conducts weekly audits of posted charges, payments, and denials for assigned insurance carriers.
  8. Ensures comprehensive accounts receivable follow up is conducted.
  9. Identifies problem areas in denials and coding errors and prioritizes work lists/workflow. 
  10. Monitors the overall revenue cycle to ensure timely and accurate payment processing. 
  11. Understands and notes any write-off delinquent accounts ensuring third party payers are closely monitored. 
  12. Obtain all required documentation, process, and maintain to ensure that all healthcare provider billing documents with government and health insurance carriers are current to avoid delays in filing medical claims.
  13. Initiates and answers pertinent correspondence.  Maintains required electronic and hardcopy financial records and files for audit purposes.
  14. Shall embrace cultural differences and interact positively with internal staff as well as external contacts in a culturally competent and respectful manner.
  15. Monitors all assigned payers and update status weekly with supervisor.
  16. Able to recognize problems with claims being denied for assigned payers. 
  17. Maintain knowledge of HIPAA regulations.
  18. Maintain knowledge of insurance payer/plans.
  19. Maintain knowledge of Standard ANSI Codes, adjustments, and remit denial codes. 
  20. Provide training and assistance to other staff relating to questions regarding payment posting, correcting errors and missing payments.
  21. Provide assistance on special projects assigned.
  22. Attend and participate in meetings as necessary.
  23. Perform other duties as assigned.

Knowledge Required:

  • Knowledge of reading and explanation of medical benefits (EOB)) and of CPT codes.
  • Knowledge of electronic payment remittances (EDI) process
  • Knowledge of third-party payers, and a thorough understanding of their processes and payment practices
  • Knowledge of Standard PC and EMR (RPMS) system(s) 
  • Knowledge of Word
  • Knowledge of Excel
  • Knowledge of Business Office Policies and Procedures
  • Knowledge of Tribal programs
  • Knowledge of ICD-10 and CPT coding 
  • Good math skills; ability to calculate fractions, decimals and percentages
  • Good verbal and written skills
  • Good organizational skills
  • The ability and skill to compile and write reports from various documents maintained within the Business Office.
  • Must maintain strict and complete confidentiality of all administrative, medical and personnel records, and all other pertinent information that comes to his/her attention or knowledge. 
  • Must have the ability to work under stressful situations
  • Must have the ability to work with patients that request their medical records.

Minimum of (1) year experience in medical billing, denial management and collections in a healthcare setting, which demonstrates expert knowledge of established professional medical billing processes, procedures and protocols.  Will possess a high degree of working knowledge and experience in RPMS 3P, A/R, medical service claims filings with a variety of health carriers, Medicare, Medicaid, both electronically and/or by paper.

In addition to the above-named duties, this position requires effective communication with other personnel in the administration and clinic environment.  

Personal Attributes: 

The incumbent must maintain strict confidentiality and high ethical standards in performing the position.  The incumbent needs to be respectful, possess cultural awareness and sensitivity, be flexible, and demonstrate sound work ethics.

How to Apply:

Complete a Northern Arapaho Tribal application form and submit it to the Northern Arapaho Human Resources program.  Applications can also be hand delivered to Northern Arapaho Human Resources at the Tribal Complex Building, located at 533 Ethete Road, Ethete, WY., or to the WRFCHC HR Department, at 120 North 6th East, Riverton, WY.  Indian preference applies.

Application forms and the full job description can be obtained on the Tribe‚Äôs website at www.northernarapaho.com, or at www.windrivercares.com