Primary Purpose:

Under indirect supervision, implement the revenue cycle using the billing status workflow process to ensure timely submission of claims, mailing of statements and subsequent payment to KPHC.

Essential Duties:

• Execute the Billing Status workflow process as follows:

Batch/Print/Submit claims, correct/reapprove rejected tickets

Transmit claims, retrieve/process EDI responses daily and correct rejections

Enter and/or Retrieve charges on a daily basis (billables & reportables)

Enter patient paid Diagnostic Laboratory Services into Practice Management System

Research/Correct Approve Failed tickets and reapprove

Batch and Print paper claims daily

Research and Correct Filed rejected daily

Review/correct and approve In progress tickets daily

Research/correct/batch and transmit all Sent tickets over 48 hours daily

Follow up on Filed Succeeded tickets over 30 days

Follow up on Filed tickets over 45 days

• Performs follow up on rejections and correspondence weekly; researches and takes action as required
• Processes insurance claims and/or reports
• Review and follow up on statements weekly
• Document all billing/collection actions taken on an individual account
• Maintains current knowledge of Sliding Fee discount program
• Abides by State collections and credit regulations
• Adheres to applicable Federal and State laws and regulations
• Support compliance and reports and/or resolves issues of non-compliance
• Maintain confidentiality at all times

Regular and reliable on-site attendance is required.

Other Duties:

Participates in billing and general staff meetings as appropriate

Cooperates with all other staff members in accomplishment of own job duties

Serves as team player, exhibiting traits of courtesy, caring, helpfulness and respect

• Maintain positive customer relationships through effective communication and follow up

Back up for front desk and/or other staff as needed

Perform other related duties and accepts responsibility as assigned

Use equipment and materials properly

Operation of common office appliances and equipment

Minimum Qualification Requirements:

Skills/Knowledge:

Knowledge of ICD-CPT coding

Knowledge of Dental procedure coding

Knowledge of Practice Management System preferred

Accurate, neat and able to complete tasks in a timely manner

Able to work alone and with initiative

Education:

High school diploma or GED equivalent required.

CPC or equivalent years of experience

Experience:

Minimum 5 years health billing experience or completion of a college degree in billing and coding required.

One (1) year of progressively responsible work experience which involved the computation and preparation of bills and demonstrated knowledge of office practices and procedures, billing methods and procedures, and the ability to interpret and apply billing regulations and policies.

Kalihi-Palama Health Center is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.