Medical Billing and Denial Specialist ($62,568 - $93,853 Annually) DOE - Muckleshoot Indian Tribe

JOB SUMMARY The Medical Billing and Denial Specialist at the Muckleshoot Health Division will be responsible for processing medical billing claims and ensuring accurate payments from third-party payers. This position focuses on denial resolution, requiring in-depth knowledge of medical billing practices. The specialist will analyze denied claims and take appropriate steps to ensure timely payment. They will also collaborate with medical providers and payers to resolve discrepancies. This role involves maintaining up-to-date knowledge of coding guidelines and insurance requirements. The ideal candidate will provide expertise in optimizing revenue cycle processes for the health department. MAJOR TASKS AND RESPONSIBILITIES This list is intended only to illustrate the various types of work that may be performed. The omission of specific statements does not exclude them from the position if the work is similar, related or logical assignment to the position. + Process third-party claims for medical billing accurately and efficiently. + Review denied claims and perform timely denial resolution to secure payment. + Collaborate with insurance companies to resolve discrepancies in billing. + Conduct audits of claims to ensure proper coding and billing standards. + Maintain accurate records of all claims submitted and payments received. + Assist healthcare providers with billing questions and necessary documentation. + Stay updated with coding and billing regulations, particularly for Medicare and Medicaid. + Prepare and submit claims appeals for improperly denied payments. + Generate and analyze billing reports to monitor revenue trends and issues. + Communicate with community members regarding billing inquiries and concerns. + Because of the Tribe's commitment to community service and the well-being of its members, each employee may be expected to perform a wide range of office and field duties from time to time. Such duties may or may not be related to their regular responsibilities. EDUCATION - EXPERIENCE AND TRAINING FOR POSITION Required: + High school diploma or equivalent. + Three (3) years of medical billing experience. Preferred: + Certification as a medical coder (e.g., CPC, CCS) and experience with Medicare, Medicaid, or other third-party payer systems. + Experience with denial resolution. SPECIFIC SKILLS/KNOWLEDGE/ABILITIES REQUIRED FOR POSITION Skills: + Proficiency in medical billing software and systems. + Strong knowledge of medical coding standards. + Expertise in claim denial resolution processes. + Attention to detail in billing documentation. + Strong communication skills with healthcare providers. + Ability to interpret insurance and payer policies. Ability: + Analyze and resolve billing discrepancies efficiently. + Communicate effectively with patients and payers. + Maintain confidentiality of patient information. + Handle multiple billing tasks simultaneously. + Work independently and with a team. + Adapt to changing billing regulations and guidelines. Knowledge: + Comprehensive understanding of medical billing processes. + Familiarity with Medicare, Medicaid, and third-party payer systems. + Knowledge of ICD-10, CPT, and HCPCS coding. + Understanding of revenue cycle management principles. + Familiarity with claim submission processes. + Awareness of HIPAA regulations in billing. PHYSICAL REQUIREMENTS The position of Medical Billing and Denial Specialist is primarily a desk job that involves extensive use of a computer for billing processes. The specialist will be required to sit for long periods of time, often up to eight hours a day. Occasional standing, walking, or lifting of light office supplies (up to 10 pounds) may be needed. The position requires good vision for reading detailed billing documents and performing data entry. The ability to focus and concentrate for long periods is essential, as accuracy is critical in this role. Occasionally, the specialist may be required to handle stress related to billing deadlines and insurance follow-up. Job LocationUS-WA-Auburn # of Openings 2 Division Health Type Regular Full-Time