Medical Billing Specialist

Pueblo of Jemez

Overview

The Pueblo of Jemez is a federally recognized sovereign Native American nation in central New Mexico with a 2014 population of 3,719.  The Pueblo of Jemez government provides services to its citizens and protects them. It ensures that proper infrastructure are set up and well maintained for the people to be happy, safe and healthy. Current operations include health and human services, education services, police protection, emergency medical services, judicial services, public works, natural resources management, social services, housing and community development - most of which are funded by federal and state governments compacts, contracts and grants.

The Jemez Comprehensive Health Center is a Federally Qualified Health Center providing comprehensive primary care and preventive care and hosts a medical clinic, dental clinic, optometry clinic, pharmacy, radiology services, mental health and substance abuse services and several community health programs.

As a member of the Business Office, the Medical Billing Specialist edits, bills and audits medical claims for payment to third party providers; and performs general office support duties, including typing, word processing and filing for the Health Center.

Responsibilities

• The Medical Billing Specialist edits & approves medical claims for the health center; including audiology, podiatry, optometry, dental & behavioral health on the Resource Patient Management System (RPMS).
• Sorts ambulance run forms by researching patient demographics; including medical insurance information; submits claims electronically or on paper for reimbursement.
• Submits non-emergency transportation claims to third party payers thru direct data entry on New Mexico Medicaid provider portal or on paper for reimbursement along established timelines and deadlines. 
• Researches and verifies patient insurance for New Mexico Medicaid when encountering errors during edit of claims in RPMS.
• Submits Breast & Cervical Cancer claims to the New Mexico Department of Health for reimbursement in accordance with submittal guidelines.
• Researches and re-submits ambulance denials to proper third party payer through established methods (electronic or paper).
• Maintains & administers provider portals for employee use to verify eligibility, check claim status or print remittance advices.
• Prepares proper documents for travel authorization approval.
• Maintains currency on changes to all third party payment plans for billing requirements and electronic claims submission requirements.
• Reviews all electronic claims to ensure claims transmitted were received and accepted at the clearing house or third party claims processing unit.
• Performs a variety of general office support duties such as typing, proofreading, filing, answering the telephone and using standard office equipment.
• Contributes to the overall quality of the unit’s service provision by developing and coordinating work teams and by reviewing, recommending and implementing improved policies and procedures.
• Represents the Pueblo with dignity, integrity, and a spirit of cooperation in all relationships with staff and the public.

Qualifications

To perform this job successfully, the individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.

Education and Experience: 

High School diploma or General Equivalency Diploma (GED); AND two (2) years of medical billing office support and administrative experience.

Certificates, Licenses, and Registrations:

• Valid New Mexico Driver’s License.

  Knowledge and Skills

   

  Knowledge of:

• Policies and procedures of third party medical billing.
• Financial record keeping and bookkeeping practices and techniques.
• Review of medical claims documents for completeness and accuracy.
• Operation of common office equipment, including computer equipment.
• Policies and procedures related to the unit to which assigned.
• Correct English usage, including spelling, grammar, punctuation, and vocabulary.
• Business arithmetic, including percentages and decimals.
• Record keeping principles and practices.
• Customer service and public relations methods and practices.
• Computer applications related to assigned duties and activities.
• Techniques for dealing with a variety of individuals from various socio-economic, ethnic and cultural backgrounds, in person and over the telephone.

Skill in:

• Providing medical billing services in an efficient, effective and accurate manner.
• Organizing work, setting priorities, meeting critical deadlines, and following up assignments with a minimum of direction.
• Maintaining accurate financial records and preparing accurate and timely reports.
• Entering claims information in electronic and paper methods.
• Organizing and maintaining accurate records and files.
• Making arithmetic calculations with speed and accuracy.
• Operating standard office equipment, including computer equipment.
• Contributing effectively to the accomplishment of team or work unit goals, objectives and activities.
• Providing customer services in the most cost effective and efficient manner.
• Using software applications related to assigned functions.
• Communicating effectively in oral and written forms.