Account representative jobs in Rapid City, SD

The Billing Coordinator handles insurance billing for third-party claims, including Medicare, Medicaid, VA, and Private Insurance. They analyze medical information from EHR and RPMS to ensure accurate claim submission and follow up on claims to secure proper reimbursement. LEVEL II reviews and investigates denied insurance claims, appeals errors, and identifies denial patterns to resolve recurring issues, maintains active status for providers by completing credentialing packages and performs business office duties to ensure maximum reimbursement from third-party payers. LEVEL III oversees Billing Coordinators, ensuring accurate claim submission and follow-up for third-party claims. They hold meetings to address issues with claims and ensure proper reimbursement is received. Essential Functions: LEVEL I • Prepare, process and submit clean claims to various insurance claims according to payer guidelines and deadlines either electronically or by paper. • Maintain current knowledge and understanding of each insurance payer's rules, regulations and deadlines and apply this knowledge in daily duties and assignments • Recognize and identify errors and communicate these to insurance payers Billing Coordinator II or III. • Monitor and reconcile delinquent accounts. • Documented ability to prioritize workload and meet quality and production standards. • Effectively communicate with clearinghouse and insurance companies regarding claim status, including rejections, denials, corrections and other various issues. • Communicate with coding department regarding coding-related denials needing correction. • Provide appropriate third-party account status and any issues to Lead Biller or Business Office Manager. • Responsible for daily clearinghouse reconciliation of reports and claims. • Answer questions from patients, clerical staff, tribes, subcontractors and insurance companies. • Perform various collection actions including contacting by phone, correcting and resubmitting claims to third party payers. • Participate in CMS, IHS and private insurers' educational activities as necessary. • Conduct self in accordance with GPTLHB's employee manual. • Maintain strict confidentiality; adhere to all HIPAA guidelines/regulations. • Perform other related duties as assigned. LEVEL II • Research payer denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment. • Independently write professional appeal letters. • Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, • Medicaid, and third-party guidelines as well as UW Health policies and procedures. • Submit retro-authorizations in accordance with payor requirements in response to authorization denials. • Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution. • Work different claims management denial lists and aging reports for all insurances. • Identify and resolve incorrect denials. • Maintain individual provider files to include up-to-date information needed to complete the required governmental and commercial payer credentialing applications • Maintain internal provider grid to ensure all information is accurate and logins are available • Update each provider's CAQH database file timely according to the schedule published by CMS • Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance • Complete revalidation requests issued by government payers • Complete enrollment applications to add providers to commercial payers, Medicare, and Medicaid • Complete re-enrollment applications for commercial payers, Medicare, and Medicaid • Work closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing • Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases LEVEL III • Provides Business Office Manager oversight of all daily activities related to the billing coordinators related to performance management. • Check-ins with each billing coordinator to go over any claims or billing issues or concerns. • Make sure all claims' lists given to the billing coordinators are completed in a timely manner • Participate in meetings pertaining to billing with the business office manager and pertinent staff . • Train all new employees (Accounts Receivable Technicians and Billing Coordinators) in the business office. REQUIREMENTS: • Participates in Core Connections training and applies GPTLHB Core Connections concepts and practices in their work. • Familiarity and/or experience working with American Indian populations and respect for and knowledge of traditional, cultural, and spiritual practices of diverse American Indian communities, as well as an ability to work with other culturally and ethnically diverse populations. • Proficiency with computer programs (Word, Excel, PowerPoint) and other Internet technologies. • Valid driver's license must be kept current, and certificates, credentials or licenses must be kept current and consistent with regulations required by applicable federal, state and/or grant regulations as applies to position. • Work in a cooperative and professional manner with OHC and GPTLHB staff. • Treat Great Plains tribes and collaborators with dignity and respect. • Utilize effective verbal and written communication skills. • Advance personal educational development by attending training sessions and seminars as appropriate. • Exemplify excellent customer service with tribal stakeholders, health board colleagues, program partners, service recipients, visitors and guests. • Foster a work environment of wellness, courtesy, friendliness, helpfulness and respect. • Consistently demonstrate respect for and acceptance of differing capabilities, cultures, gender, age, sexual orientation and/or personalities. • Maintain and ensure organizational privacy and confidentiality. • Promote an alcohol, tobacco and drug-free lifestyle. Minimum Qualifications: LEVEL I: High school diploma or GED and one (1) year of medical billing experience. LEVEL II: High school diploma or GED and one (1) year of medical billing experience; Three (3) years of service at Great Plains Tribal Leaders Health Board/Oyate Health Center; or demonstrated proficiency as Billing Coordinator at Level I LEVEL III: High school diploma or GED and one (1) year of medical billing experience; Five (5) years of service at Great Plains Tribal Leaders Health Board/Oyate Health Center; or demonstrated proficiency as Billing Coordinator at Level II. Complete Billing Certification within one (1) year of employement. The GPTLHB is a tribal organization that follows tribal preference laws. Our policy is to give preference to qualified Indian/Tribal candidates over qualified non-native candidates in hiring decisions if all other qualifications are equal. Employment is contingent upon the outcome of all required criminal background checks. Employee Health Requirements: Compliance with our Employee Health Procedure is a condition of employment. You are required to agree that you will comply with all job-related employee health screening and immunizations prior to your first day of employment. Jobs require that you have documentation that you have completed the following immunizations prior to your first day of employment: MMR (Measles, Mumps and Rubella, Varicella (Chicken Pox), Hepatitis B, Influenza, T-dap (Tetanus - Diphtheria - Pertussis), and COVID-19 vaccination is required.