Electronic Health Record & Billing Specialist

Job Code: 29-2072 Salary: $15.02 - $31.68

Status: Non-exempt, Full-time, Permanent Location: Family Support Building

Department: Family Support Program Reports To: Program Manager

Telecommute: No Fleet: No

SUMMARY: Under the direction of the Family Support Program Manager, this position is responsible for implementing the Electronic Health Record (EHR) and all aspects of billing relating to Home and Community-Based Services. It also oversees ongoing management and maintenance, ensuring data integrity, compliance, proper utilization, and maximum revenue reimbursement for the Family Support Program.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

· At all times, serve as an advocate for the individual with whom you work.

· Responsible for planning, coordinating, and administering the daily functions of all Electronic Medical Records and addressing all staff questions, including the maintenance of systems to ensure that they are always running at maximum speeds, fully functional, and accessible at all times to all staff who require the use of them.

· Responsible for establishing and maintaining a complete electronic medical record for each program participant in accordance with regulatory and professional standards, including, but not limited to, seeing that medical records are completely documented and properly organized, easily accessible to facilitate retrieval of information, coded to conform to all state and federal standards.

· Assists and provides data from all electronic medical record systems for audits and study projects involving care and utilization of services.

· Manage and maintain all records, including participating in continuous quality improvement activities directly related to the oversight of EHR.

· Create service authorizations to put in the online system.

· Keeps current with state and federal regulation changes relating to medical records and Medicaid billing.

· Leads EHR development and optimization projects to improve clinical and financial workflows and manages tasks therein.

· Gather and process information needed to complete claims for payment.

· Investigate pending claims and resolve discrepancies via phone, insurance portals, fax, etc. Resolve claims rejections in a timely fashion and monitor payer acceptance of claims;

· Determine why a claim was denied and resolve claim denials within established time frames.

· Track rejected, denied, appealed, and corrected claims to ensure payment.

· Identify claims needing corrections and resubmit following proper methods and timelines

· Manages and ensures each claim is resolved appropriately and successfully.

· Responsible for maintaining current billing, coding, and standard operating procedures (SOP) files as a desk reference.

· Submits initial and corrected claims according to a schedule that supports timely billing and maximizes the Medicaid claiming cycle.

· Participate in program billing meetings and provide status reports to the Program Manager.

· Other related duties as assigned by the Program Manager.

SUPERVISORY RESPONSIBILITIES: There are no supervisor requirements for this position.

QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to satisfactorily perform each essential duty. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

EDUCATION and/or EXPERIENCE:

· High School Diploma. AND

· 1 year of experience and training in the area of Medicaid billing and/or Electronic Health Record management. PREFERRED

· Certification in EHR management and familiarity with federal and state Medicaid billing practices. PREFERRED

OTHER SKILLS and ABILITIES: Strong oral and written communication skills are required. Excellent computer skills, including Word and Excel, and experience with varying databases are also required. Computer testing in the applicable skills may be a requirement during the interview process.

This position mandates employees to report to or remain at work in the event of an emergency, crisis, or staff shortage until relieved by their immediate supervisor.\

REASONING ABILITY: Ability to solve practical problems and deal with various concrete variables in situations with limited standardization. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

The Saint Regis Mohawk Tribe strives to be an equal opportunity employer dedicated to the policy of nondiscrimination based on race, sex, marital status, sexual orientation, religion, national origin, age, physical disability, veteran status, or any other non-job-related factor.

The successful candidate must pass a test for illegal substances and a criminal background check before employment is confirmed.