Third Party Billing

Prepared on March 10, 2025

Department	Wellness Center
Reports To	Third Party Billing Manager Administrator
Type of Employment	Full-Time
Work Hours	08:30-04:30
FLSA Status	Non-Exempt
Salary	$27.00 - $30.00/h DOQ

Summary

The position requires knowledge including but not limited to Medical, Behavioral Health, and Dental billing in reviewing for accuracy of billing and for payments made, following up with insurance companies on past due and denied claims, following up with patients regarding outstanding bills, posting payments, and running reports as requested.

Job Description

Essential Duties and Responsibilities

Knowledge of coding policies and procedures, reimbursement practices.
Enter/edit claims based on office policies, payer policies and specific coding criteria.
Medicare/Medicaid/Private Insurance practices.
ADA, ICD-10, CPT and HCPCS code sets
Reviews inquiries from insurance company related billing specifics, such as coding/requested information, denials in a timely manner.
Shares information on any significant changes in coding, benefits, coding errors, etc.
Keeps in close contact with the insurer to better understand their specific guidelines and plan changes.
Reviews records to ensure completeness, accuracy, and timeliness.
Work assigned work-ques.
Resolve electronic claim rejections.
Prints, sorts, and mails manual claim forms (private and dental) to insurer.
Monitor and collect accounts receivables.
Answers accounts receivable telephone inquiries and follows up.
Maintains contact with patients and outside vendors.
Reviews coded information for accuracy and completeness. Assists with coding and error resolution.
Processes and distributes copies of billings according to clinic policies.
Follows up on accounts until zero balance or turned over to collection.
Post EOB’s to patient accounts and balances to deposit report.
Obtains and mails invoice copies for patients, as requested.
Files EOB’s and deposit report.
Research and processes customer claims.
Research and processes charge backs, returns, and NSF checks.
Log electronic fax payments/distribute to proper department to run payment.
Print, review, and mail monthly statements.
Pick up mail, open/sort/deliver to proper departments.
Calls and/or mails correspondence to patients as necessary in order to update accounts.
Credentialing/enrollment process for new providers:
Medicare
Medicaid
Private insurances
Recredentialing process as requested (every 3 to 5 years),
Collections (as necessary)
Quarterly demographic updates for HCA and private insurance carriers.
Maintain provider files with current contracts and correspondence.
Assists with related special projects, as required.
Maintains strict confidentiality & observes HIPAA regulations.
Other duties as assigned.
Maintains current, active, valid, unrestricted Washington State licensure and CEU’s (as necessary).
Maintains current CPR certification.
Participates in the Tribe’s quality improvement and planning activities as necessary.
Works cooperatively with the Health Director, Wellness Center Staff.
Observes strict patient confidentiality, and all pertinent requirements of HIPAA and any other confidentiality regulations.
Performs any additional reasonable roles and responsibilities as determined necessary by the Health Director.

Safety

Demonstrates knowledge of CDC, Dept. of Health, OSHA standard as it applies to the clinic environment.
Adheres to universal precautions.

The above statements are intended to describe the general nature and level of work performed by a person in this position. They are not to be construed as an exhaustive list of all duties that may be performed in such a position.

Supervisory Requirements

This position has no supervisory responsibilities.

Experience and Eduction

1-2 years of billing experience REQUIRED
EPIC &/or Dentrix knowledge preferred
Associate’s degree (A.A.) or equivalent from two-year College or technical school in the billing field; or two or more years related experience and/or training; or equivalent combination of education and experience.

Skills

LANGUAGE SKILLS:

Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to patients, clients, and other employees of the organization.

MATHEMATICAL SKILLS:

Basic mathematical skills; addition, subtraction, multiplication, division, decimals and fractions. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

REASONING ABILITY:

Ability to apply common sense understanding to carry out detailed, but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit. The employee is occasionally required to reach with hands and arms, stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 10 pounds. Working under stress and use of telephone required. Manual dexterity required for use of calculator and computer keyboard.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Common office environment.

At-Will Employment

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employee(s) will be required to follow any other job related instructions and to perform any other job related duties requested by any person authorized to give instructions or assignments.

The employment relationship with Shoalwater Bay Indian Tribe is voluntary; there is no specified length of employment. Accordingly, either the Shoalwater Bay Indian Tribe or the employee may terminate the employment relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

This document does not create an employment contract, implied or otherwise.

Benefits

After 60 days of employment

Medical
Vision
Dental
Life and Accidental Death & Dismemberment coverage
Short term disability
Long term disability
Disability resources

After 90 days of employment

Annual Leave accrual
Sick Leave accrual
Bereavement Leave
Military Leave
Jury Duty Leave
Paid Holidays

After 1 year of employment

401K contribution

Work Location	Work on Location Premises 2373 Tokeland Rd Bldg E Tokeland, Wa 98590
Job Posting Valid Through	Valid until filled
Position Start Date	Immediately