Revenue Coding Specialist I-TH
Yasama Nation, Toppenish, WA, United States
Overview
Revenue Coding Specialist I – Tribal Health. Hourly Wage: $26.94/Regular/Full-Time. The purpose of this position is to abstract and code a patient\'s health record according to federal, state, and tribal rules and regulations to aid in third-party billing. The role requires substantial experience and understanding of the healthcare billing industry, including ICD-10 and CPT coding. Responsibilities include capturing patient demographics from two clinic facilities, entering, reviewing, and preparing patient and insurance data in the eClinical Works system, researching and verifying billing data accuracy, and revising billing errors including adjustments and denials. The position also serves as a Tribal Assister/Navigator to provide patients with a basic overview of insurance, the Affordable Care Act, the Health Benefit Exchange, and Washington Healthplanfinder. Responsibilities
Review patient logs, demographics, and insurance eligibility to ensure billing is captured for all patients and completed accurately. Safeguard confidentiality of medical charts/electronic health records and comply with federal, state, and tribal laws; ensure HIPAA compliance for use, retrieval, storage, and sharing of medical records. Monitor daily electronic claim billing processes; report billing discrepancies to Revenue Specialist II. Stay up to date on current coding and billing regulations and departmental policies. Assist with third-party payer and other audit requests by compiling and organizing documentation. Coordinate patient eligibility through various third-party sources and issue adjusted, corrected, and/or rebilled claims to third-party payers. Educate and assist clients and families with the insurance application process through the Healthcare Exchange (web portal or Exchange Call Center). Assist patients with enrollment in Medicare plans (Part B) and related Washington Connections applications; file exemptions for those who opt out of ACA. Verify provider licensing for credentialing, privileging, and credentialing purposes. Ensure records comply with Indian Health Services standards and applicable WA Health regulations. Utilize Yakama Nation health information systems and related EHR systems to maintain records and generate reports. Assist in setting up programs to transition data collection systems as needed. Prepare billing files of claims and encounters to ensure all services are reported; align procedure and diagnosis codes with documentation in the client record. Monitor claim submissions, review rejected claim reports, and research and resolve errors; resubmit corrected encounters/claims as required. Understand Medicaid, private and employee insurance provisions, and ACA-related considerations for American Indian or Alaska Native populations. Access ProviderOne via OneHealthPort to verify eligibility, view paid/denied claims, and submit adjusted claims, including EOB verification. Demonstrate working knowledge of medical terminology and health information laws; understand accreditation standards and compliance; lead and coach clinical/SUD staff in claims documentation. Collaborate with outside providers to coordinate services with client insurance information and referrals; support insurance coverage applications as needed. Establish and maintain professional relationships with coworkers, administrators, vendors, patients, and the public. Knowledge, Skills and Abilities
Verify provider licensing requirements with WA State Department of Health for Substance Use Disorder professionals and related roles. Adhere to IHS/ISDEAA PL 93-638 contract, CMS, and IHS MOA to facilitate Medicaid billing; follow WA state plan amendments. Maintain records in accordance with IHS standards and WA DOH regulations. Ability to use Yakama Nation Tiinawit health information systems, RPMS EHR (BH-MIS), and related tools for record keeping and reporting. Ability to utilize systems (e.g., eClinical Works) and to support system transitions (e.g., data collection system changes). Billing specialization in claims and encounters; ensure alignment of codes with documentation. Knowledge of Medicaid, private, and employee insurances and ACA provisions for AI/AN populations. Access to ProviderOne via OneHealthPort for eligibility checks and claim management. Working knowledge of medical terminology, physiology, and legal aspects of health information. Understanding accreditation/Compliance requirements; ability to lead and coach. Collaborative abilities to work with clinical/SUD staff and external providers. Proficiency with Microsoft Office and basic internet skills. Minimum Requirements
High School Diploma or GED with 2–4 years of experience in medical billing or medical data entry. CPB or CPC certification from a recognized professional organization; three years of work experience with Native American communities and/or Tribal Health Billing preferred. Maintain confidentiality and comply with HIPAA; protect sensitive information. Tribal Assistor Certification preferred or ability to obtain within 90 days. Pass pre-employment background check. Valid Washington State Driver\'s License and proof of insurance. Pass pre-employment drug test. Preferred Requirements
Documented training/experience in maintenance of medical records and ICD-10-CM/DRG coding; eClinical Works or EHR systems experience preferred. Enrolled Yakama Preference; all qualified applicants encouraged to apply.
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Revenue Coding Specialist I – Tribal Health. Hourly Wage: $26.94/Regular/Full-Time. The purpose of this position is to abstract and code a patient\'s health record according to federal, state, and tribal rules and regulations to aid in third-party billing. The role requires substantial experience and understanding of the healthcare billing industry, including ICD-10 and CPT coding. Responsibilities include capturing patient demographics from two clinic facilities, entering, reviewing, and preparing patient and insurance data in the eClinical Works system, researching and verifying billing data accuracy, and revising billing errors including adjustments and denials. The position also serves as a Tribal Assister/Navigator to provide patients with a basic overview of insurance, the Affordable Care Act, the Health Benefit Exchange, and Washington Healthplanfinder. Responsibilities
Review patient logs, demographics, and insurance eligibility to ensure billing is captured for all patients and completed accurately. Safeguard confidentiality of medical charts/electronic health records and comply with federal, state, and tribal laws; ensure HIPAA compliance for use, retrieval, storage, and sharing of medical records. Monitor daily electronic claim billing processes; report billing discrepancies to Revenue Specialist II. Stay up to date on current coding and billing regulations and departmental policies. Assist with third-party payer and other audit requests by compiling and organizing documentation. Coordinate patient eligibility through various third-party sources and issue adjusted, corrected, and/or rebilled claims to third-party payers. Educate and assist clients and families with the insurance application process through the Healthcare Exchange (web portal or Exchange Call Center). Assist patients with enrollment in Medicare plans (Part B) and related Washington Connections applications; file exemptions for those who opt out of ACA. Verify provider licensing for credentialing, privileging, and credentialing purposes. Ensure records comply with Indian Health Services standards and applicable WA Health regulations. Utilize Yakama Nation health information systems and related EHR systems to maintain records and generate reports. Assist in setting up programs to transition data collection systems as needed. Prepare billing files of claims and encounters to ensure all services are reported; align procedure and diagnosis codes with documentation in the client record. Monitor claim submissions, review rejected claim reports, and research and resolve errors; resubmit corrected encounters/claims as required. Understand Medicaid, private and employee insurance provisions, and ACA-related considerations for American Indian or Alaska Native populations. Access ProviderOne via OneHealthPort to verify eligibility, view paid/denied claims, and submit adjusted claims, including EOB verification. Demonstrate working knowledge of medical terminology and health information laws; understand accreditation standards and compliance; lead and coach clinical/SUD staff in claims documentation. Collaborate with outside providers to coordinate services with client insurance information and referrals; support insurance coverage applications as needed. Establish and maintain professional relationships with coworkers, administrators, vendors, patients, and the public. Knowledge, Skills and Abilities
Verify provider licensing requirements with WA State Department of Health for Substance Use Disorder professionals and related roles. Adhere to IHS/ISDEAA PL 93-638 contract, CMS, and IHS MOA to facilitate Medicaid billing; follow WA state plan amendments. Maintain records in accordance with IHS standards and WA DOH regulations. Ability to use Yakama Nation Tiinawit health information systems, RPMS EHR (BH-MIS), and related tools for record keeping and reporting. Ability to utilize systems (e.g., eClinical Works) and to support system transitions (e.g., data collection system changes). Billing specialization in claims and encounters; ensure alignment of codes with documentation. Knowledge of Medicaid, private, and employee insurances and ACA provisions for AI/AN populations. Access to ProviderOne via OneHealthPort for eligibility checks and claim management. Working knowledge of medical terminology, physiology, and legal aspects of health information. Understanding accreditation/Compliance requirements; ability to lead and coach. Collaborative abilities to work with clinical/SUD staff and external providers. Proficiency with Microsoft Office and basic internet skills. Minimum Requirements
High School Diploma or GED with 2–4 years of experience in medical billing or medical data entry. CPB or CPC certification from a recognized professional organization; three years of work experience with Native American communities and/or Tribal Health Billing preferred. Maintain confidentiality and comply with HIPAA; protect sensitive information. Tribal Assistor Certification preferred or ability to obtain within 90 days. Pass pre-employment background check. Valid Washington State Driver\'s License and proof of insurance. Pass pre-employment drug test. Preferred Requirements
Documented training/experience in maintenance of medical records and ICD-10-CM/DRG coding; eClinical Works or EHR systems experience preferred. Enrolled Yakama Preference; all qualified applicants encouraged to apply.
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