Revenue Coding Specialist

Revenue Coding Specialist I

Tribal Health

Hourly Wage: $26.94/Regular/Full-Time

Announcement #:  Issue Date: 02-24-26 Closing Date: 03-16-26

The purpose of this position is to abstract and code a patient's health record, according to federal, state, and tribal rules and regulations that will help process third party billing. This position will process claims and requires substantial experience and understanding of healthcare billing industry including ICD-10 + CPT coding. Responsibilities entail capturing patient demographics from 2 clinic facilities, entering, reviewing, and preparing patient and insurance date into e-clinical works system, researching, and verifying accuracy of billing data and the revision of billing errors including adjustments and denials.

This position will also serves as a Tribal Assister, Navigator to provide patients with a basic overview of insurance, including common terms, background on the Affordable Care Act, the Health Benefit Exchange, and Washington Healthplanfinder.

• Responsible for reviewing patient logs, demographic, insurance eligibility and other activity to ensure billing is captured for all patients and completed accurately.
• Safeguards confidentiality of the medical charts/electronic health records and complies with all federal, state and tribal laws pertaining to medical records. Assures compliance with HIPAA regulations concerning use, retrieval, storage, and sharing of medical records.
• Monitor insurance electronic claim billing process is completed successfully on a daily basis. 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 request, by compiling and organizing documentation.
• Coordinate the process of patient eligibility through various third-party sources and issue adjusted, corrected, and/or rebilled claims to third party payers.
• Educate and aid clients and their families with the insurance application process through the Healthcare Exchange, using the web portal or by calling the Exchange Call Center.
• Assist patients with signing up for Medicate plans: B, D & F, with Washington Connections Applications, and with filing exemptions for those who opt out of ACA.

• Verify provider licensing with WA State Department of Health requirements for Substance Use Disorder Professionals, trainees, agency affiliates for legal, privileging and credentialing purposes.
• Adherence to I.H.S. ISDEAA PL 93-638 contract, CMS, and I.H.S. Memorandum of Agreement to facilitate Medicaid billing, follow State of WA for amendments and changes to State plan provision that may affect billing.
• All records will be maintained in accordance with Indian Health Services Standards, (I.H.S. Health manual, part 3, Chapter 18, and Washington State Department of Health (WAC .
• Ability to utilize Yakama Nation Tiinawit health information systems, RPMS E.H.R. (BH-MIS), Electronic Health Record (eCR, Target-treatment & assessment report generation tool, will be used to maintain records and collect date).
• Assisting with setting up program to change data collection system from Targe to B.H.D.S-(behavior health data store system).
• Billing Specialization-preparing billing files of claims and encounters to ensure that all services are reported.
• Ensure that procedure codes and diagnosis codes are aligned with the documentation in the client record.
• Monitor claim and encounter files submissions, review rejected claim and encounter reports, research and resolve errors in rejected claims. Ensure all encounters and claims are resubmitted after correction.
• Knowledge and understanding of the Medicaid, private insurance, employee insurance and the special provisions in the Affordable Care Act regarding American Indian/Alasa Natives.
• Ability to utilize accessing OHP-One Health Port  to access Provider One, for pt eligibility, access paid/denied claims, submit adjusted claims, verify EOB-explanation of benefits to verify payment.
• A working knowledge of medical terminology and physiology and legal aspects of health information
• Knowledge…