Billing Specialist II

Open: 11/25/2025

Close:
Until Filled

POSITION DESCRIPTION

POSITION: BILLING SPECIALIST II

RESPONSIBLE TO: Business Office Manager

SALARY: Step Range: 12 ($40,453)
-31($70,934);
Full Benefits

CLASSIFICATION: Non-Management, Regular, Full-Time

LOCATION:

Klamath Tribal Health & Family Services

3949 S. 6th Street, Klamath Falls, Oregon

BACKGROUND: Comprehensive

POSITION OBJECTIVE

Klamath Tribal Health & Family Services (KTHFS) is a tribally-operated health facility offering direct medical, dental, pharmacy, behavioral health, and non-emergent transportation services to Native Americans and Alaska Natives residing within the service delivery area. The Billing Specialist is responsible for managing patient accounts in a complex, multi-disciplinary Business Office environment. The incumbent shall cross-train with other members of the Klamath Tribal Health Business Office Staff and shall participate in all functions of the coding and billing cycle, to include: daily review of encounters, analyzing chart notes and assuring the appropriate service codes are utilized, data entry of encounter forms, posting charges into the computer system, perform claims review, claims submission, timely billing, follow-up and collection of all accounts, payment posting, claims audit and research.

The incumbent shall also function as a resource for clinic providers and staff and will assist with coding and billing questions, and quality assurance activities.

MAJOR DUTIES AND RESPONSIBILITIES

1. Daily review, analyze, and interpret patient ambulatory EHR and/or paper encounter coding and corresponding chart note documentation and determine that the appropriate diagnostic and procedural codes are used and appropriately reflected in the chart note for code assignment as outlined by the CMS guidelines. Assuring that medical/dental necessity billing guidelines are met.

2. Ensure the appropriate service codes are applied in the billing record that corresponds to the documentation referenced in the chart note or on the encounter forms. Ensure that the appropriate ICD-10, CPT, HCPCS, CDT coding conventions have been used for services provided by all health service types within KTHFS, including but not limited to: medical, dental, behavioral health and transportation.

3. Work with providers and nursing staff to clarify documentation in the EHR system if needed. Including correlating anatomical and physiological processes of a diagnosis to assure the most accurate ICD-10 code(s) are used. Advise supervisor and clinicians of deficiencies to support charge capture of all billable services.

4. Prepare and submit clean claims (electronic or paper) to primary/secondary insurance carriers including Medicaid, Medicare, (Part A&B), and private insurance companies.

5. Maintain compliance with billing regulations: including Medicaid (DMAP), Medicare (Parts A&B, DME), Private Insurance Carriers (i.e. HMA, BCBS, ODS, etc.).

6. Payment post insurance checks or EFTs, which includes: verifying the checks or EFTs that have been receipted in the KTHFS Operations Support System, batching the checks or EFTs into the current billing system, and then accurately posting the payments into the current billing system.

7. Process refunds for any over payments made to KTHFS. Monitor claims payment and promptly request POs for refunds to insurance companies, or perform electronic claim adjustments per payer requirements, for any over payments made on claims. The refund will also be processed to reflect the claim refund in the practice management system.

8. Process No-Pay EOBs, applying an adjustment, create billing notes and claim follow-up. This includes the appeal of insurance claims that have been wrongfully paid or denied, contacting insurance companies by phone to obtain information concerning extent of benefits and/or settle unpaid claims and providing any additional information requested by insurance companies for the processing of submitted claims.

9. Record in Next Gen system all claims related phone calls, correspondence, and activities related to each patient account.

10. Maintain current filing system for encounters, POs, & etc.; process daily incoming mail and correspondence for review, completion, and filing.

11. Communicate regularly with Patient Registration Staff and record patient benefit effective/term date(s) into the practice management system as needed.

12. Create electronic batches to submit to clearinghouse in Nextgen and reconcile to claims spreadsheet including follow up on electronic claims receipt by payer. Correct any claims before archiving the file in the clearinghouse.

13. Work outstanding A/R by reviewing, rebilling, and adjusting accounts to ensure accurate and thorough billing of claims, by running reports and working on claims. Track and monitor claims processing, ensure timely follow-up for the payment of bills;
Identify, and resolve all outstanding/pending claims.

14. Monitor the Business Office outlook inbox regularly and back bill any claims and/or adjust…