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Klamath Tribal Health & Family Servicesth3949 South 6 StreetKlamath Falls, OR 97603Phone: (541) 882-1487 or 1-800-552-6290H.R. Fax: (541) 273-4564EXEMPTNON-EXEMPT XOPEN: 03/28/17CLOSE: 04/17/17POSITION DESCRIPTIONPOSITION:BILLING SPECIALIST (PART-TIME)RESPONSIBLE TO:Business Office ManagerSALARY:GS-6 31,063 - 39,941 Annual/Part-Time BenefitsGS-7 34,137 - 44,371 Annual/Part-Time BenefitsGS-8 Only for Employees with 10 years of ServiceCLASSIFICATION:Non-Management, Regular, Part-TimeLOCATION:Klamath Tribal Health & Family Services3949 S. 6th Street, Klamath Falls, OregonPOSITION OBJECTIVEKlamath Tribal Health & Family Services is a tribally-operated health facility offering directmedical, dental, pharmacy, behavioral health, and alcohol/drug counseling services to NativeAmericans and Alaska Natives residing within the service delivery area. Non-emergencytransportation services are also offered. The Billing Specialist is responsible for managingpatient accounts in a complex, multi-disciplinary business office environment. The incumbentshall cross-train with other members of the Klamath Tribal Health Business Office Staff and shallparticipate in all functions of the billing cycle, to include: data entry of encounter forms,posting charges into the computer system, perform claims review, claims submission, timelybilling, follow-up and collection of all accounts, payment posting, claims audit and research.The incumbent shall also function as a resource for clinic providers and staff and will assist withbilling questions, and quality assurance activities.MAJOR DUTIES AND RESPONSIBILITIES1. Daily review, analyze, and interpret patient ambulatory EHR and/or paper encounter codingand chart note documentation and assure that the appropriate ICD-9-CM & CPT, CDT codesare accurate as outlined by the CMS guidelines. Assure medical/dental necessity billingguidelines are met.Job Description: Billing SpecialistRevised: 03/28/2017Page 1 of 7

2. Accurately enter information from encounter forms, or from chart notes, by assuring theappropriate ICD-9, CPT, HCPCS, CDT coding conventions have been used for servicesprovided by all clinic types within KTHFS, including but not limited to: medical, dental,alcohol & drug treatment and transportation.3. Work with providers and nursing staff to clarify documentation on the encounter forms ifneeded. Including correlating anatomical and physiological processes of a diagnosis toassure the most accurate ICD-9 code(s) are used.4. Determine billable claims; Prepare and submit clean claims (electronic and/or paper) toprimary/secondary insurance carriers including Medicaid, Medicare (Part A&B), and PrivateInsurance Companies.5. Determine billable accident claims (etc. Workman’s Comp, MVA, Liability claims) and verifyand/or acquire all needed information in order to bill the claims. Work with PatientRegistration, Medical Records, the providers, and possibly the patient, to acquire theinformation needed to bill the claims. Submit clean claims with chart notes to specifiedaccident insurance carrier.6. Payment posting of insurance checks, which includes: verifying the checks that have beenreceipted in the Check Receipt Tracking System, batching the checks into the current billingsystem, and then accurately posting the payments into the current billing system.7. Refund processing for any overpayments made to KTHFS. Monitor claims payment andpromptly request POs for refunds to insurance companies, or perform electronic claimadjustments per payer requirements, for any overpayments made on claims. The refund willalso be processed to reflect the claim refund in the practice management system.8. Posting of No-Pay EOBs, applying an adjustment and/or creating billing notes and claimfollow-up. This includes the appeal of insurance claims that have been wrongfully paid ordenied, contacting insurance companies by phone to obtain information concerning extentof benefits and/or settle unpaid claims and providing any information requested byinsurance companies for the processing of submitted claims.9. Work the outstanding A/R by reviewing, rebilling, and adjusting accounts to ensure accurateand thorough billing of claims, by running reports and working on claims. Track and monitorclaims processing, ensure timely follow-up for the payment of bills; Identify, and resolve alloutstanding/pending claims.10. Run specific reports as identified below: To be ran and worked weekly - Pending Charges Report, Paper Claims printed Biweekly reports - Kept Appointments with No Encounters report, Unbilled Encountersreport Monthly reports - Aging Reports, and maintain up to date reports making sure all oldbilling is addressed.Job Description: Billing SpecialistRevised: 03/28/2017Page 2 of 6

11. Record on NextGen system all claims related phone calls, correspondence, and activitiesrelated to each patient account.12. Maintain and/or develop a current filing system for encounters, POs, & etc.; process dailyincoming mail and correspondence for review, completion, and filing.13. Establish and maintain an effective working relationship with public and private payers;identify potential problems that could cause interruptions to cash flows.14. Maintain compliance with billing regulations: including Medicaid (DMAP), Medicare (PartsA&B, DME), Private Insurance Carriers (i.e. Lifewise, BCBS, ODS, etc.).15. Respond to third-party Release of Information requests for itemized billing and servicesrendered. Coordinate process with Records Department to ensure the appropriateinformation is provided based on privacy rules and regulations.16. Communicate regularly with Patient Registration Staff and record patient benefiteffective/term date(s) into the practice management system as needed.17. Advise supervisor and clinicians of deficiencies to support charge capture of all billableservices.18. Participate in quarterly chart audit activities for quality assurance purposes; documentresults in report format, as needed, to be able to have reviewed by Clinical Director.19. At month’s end, after all payment batches have been posted, run month end reports out ofNextGen and RPMS. Use the appropriate data to complete the Business Office End ofMonth Report and fill in the needed fields on the Business Office Excel Spreadsheet.Distribute program income reports monthly and/or as requested20. Compile reports as requested for department managers and distribute in a timely fashion.21. Print Electronic Send Report/ Batch Summary when electronic claims are billed out andreconcile to electronic claims spreadsheet including follow up on electronic claims receiptby payers.22. Attend coding seminars, meetings, or other training opportunities to keep abreast ofchanges in the profession; attend quarterly OR DMAP Billing Provider meetings.23. Perform other duties as assigned.SUPERVISORY CONTROLSWork under the supervision of the Business Office Manager, who provides general instructions.Work is assigned in terms of functional/organizational objectives. The manager assists withunusual situations that do not have clear precedents.Job Description: Billing SpecialistRevised: 03/28/2017Page 3 of 6

Employee must be able to work with minimal supervision, using initiative and judgement insetting priorities to meet the demands of the workload. Work is performed within the purviewof laws, and regulations. The manager will review work regularly for quality and compliancewith established policies and procedures and payer guidelines.KNOWLEDGE, SKILLS, ABILITIESTechnical knowledge, skill, and understanding of the American Medical Association developedCPT-4 coding system in order to acquire, interpret, and resolve problems based on informationderived from system monitoring reports to be carried over to the required billing forms.Technical knowledge, skill, and understanding of the concepts of the International Classificationof Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) for classification of diseasesand/or procedures.Knowledge and understanding of CDT dental coding system.Basic knowledge and understanding of HCPCS.Knowledge of mental health and alcohol and drug coding and billing is desirable.Ability to work with minimal supervision, using initiative and judgment in setting priorities tomeet the demands of the workload while adhering to the insurance rules and regulations thatrelate to coding and billing.The knowledge of and/or the ability to learn the billing guidelines as they pertain toFQHC/Tribal Health Clinics.Knowledge of established procedures, required claim forms (both paper and electronic)associated with the various health insurance programs.In-depth knowledge of Medicaid (OARs, Rulebooks).In-depth knowledge of Medicare Part A & B billing regulations.Knowledge of medical terminology.Knowledge of claims review, account auditing, and quality assurance.The ability of tracking, handling, and completing multiple projects.Ability to communicate well (both orally and in writing) and work effectively with otheremployees, managers, and administrators. This person should be able to express themselves ina clear and concise manner for the purposes of correspondence, reports and instructions, asJob Description: Billing SpecialistRevised: 03/28/2017Page 4 of 6

well as for obtaining and conveying information to ensure a cooperative working relationshipwith all staff.Willingness to maintain expertise to keep current with changes in procedure and diagnosiscoding and third-party payer reimbursement policies through continuing education.Above average ability to work with numbers and set standards in order to assure properpayment and adjustments posting.Must be dependable, thorough, accurate, well-organized and detail oriented.Ability to maintain strict confidentiality of medical records and adhere to the standards forhealth record-keeping, HIPAA and Privacy Act requirements.Conduct self in accordance with KTH&FS Employee Policy & Procedure Manual.Ability to work with minimal supervision.QUALIFICATIONS, EXPERIENCE, EDUCATIONMinimum Qualifications: Failure to comply with minimum position requirements may resultin termination of employment. REQUIRED to possess a High School Diploma or Equivalent. (Must submit copy of diploma ortranscripts with application.) REQUIRED One (1) year of medical and/or dental billing experience and/or data entryexperience which demonstrates the technical knowledge of medical terminology and theCPT and ICD-9-CM coding systems OR Medical Coder certification, Dental Codercertification, or an Associates degree in medical office systems will be accepted in place ofexperience. Experience must be reflected on application; or submit copy of codercertification with application. REQUIRED Must obtain, at own expense, one of the following certifications: CertifiedProfessional Coder (CPC), Certified Coding Specialist (CCS), or Registered Medical Coder(RMC) within one (1) year of hire date. REQUIRED to have Computer and/or word processor experience. REQUIRED to type/keyboard a minimum of 30 wpm with accuracy. Certification oftyping/keyboarding ability is required. (Must submit a certified 3-5 minute test withapplication; test may not more than 6 months old.) REQUIRED to submit to a background and character investigation, as per Tribal policy.Following hire must immediately report to Human Resource any citation, arrest, conviction fora misdemeanor or felony crimeJob Description: Billing SpecialistRevised: 03/28/2017Page 5 of 6