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Ke Ola Mamo
Position Title: Medical Billing and Administrative Specialist
Reports To: Medical Director
Program: KOM Clinic
FLSA Status: Exempt
FTE: 1.0 PHI Security Clearance: Level 1 A ccess to client information. Administrative/professional employee who performs work direclty related to management policies and whose duty consists of the performance of work requiring knowledge of an advanced type acquired by a prolonged course of specialized training and consistently exercises discretion and judgment.
Position Summary
The Medical Biller will be responsible for managing the entire medical billing process from start to finish, ensuring successful execution of a revenue management cycle that converts healthcare services into financial reimbursements. Candidates must have experience in medical billing and should be detail-oriented with excellent organizational, time management, and verbal & written communication skills.
Essential Duties and Responsibilities
Collaborate with providers, clinic staff, health insurance companies, and patients to ensure completion of every step of the medical billing process.
Ensure accuracy of patient and health insurance information, including verification of patient data, health insurance coverage, eligibility, and benefits.
Review provider documentation of the services rendered and medical coding assigned, and enter the appropriate charges for the services, procedures, and supplies into the billing system.
Verify accuracy and compliance of each claim prior to submission.
Submit electronic claims to primary, secondary, and tertiary payors, which include Medicare, Medicaid, and commercial health insurances.
Maintain a tracking procedure which accounts for claims submitted and their outcome.
Manage posting of payments by recording the payment received from the health insurance company, ERAs (electronic remittance advice), and manual/paper checks.
Collaborate with providers by correcting and processing denied or unpaid claims, including submission of appeals and resubmissions.
Submit and track late payments from payors and patients.
Generate and issue statements for any remaining patient responsibility such as co-pays, deductibles, or sliding fee scale, and assist clinic staff with collecting and processing payments and unpaid statements.
Implement any changes or updates to the sliding fee scale as determined by management and the Director of Finance.
Assist with completion and submission of clinical documents which support additional generation of revenue, such as health insurance quality incentive programs.
Support clinic efficiency and ensure health insurance coverage for services by assisting providers with prior authorization submission and tracking.
Ensure providers are eligible for reimbursement from payors by managing the credentialing process, including gathering and submitting all required documents for credentialing and re-credentialing with all participating health insurances.
Maintain credentialing system data and documentation filed in the medical staff office and credentialing software, in compliance with State and Federal regulations and policies, internal and external auditors of compliance, and all applicable accreditation standards.
Monitor licenses and credential expiration dates, and advise staff members of required renewal dates.
Generate reports as requested by supervisor or management on the status of various stages of the medical billing process.
Perform other duties as required or assigned by supervisor.
Other Duties and Responsibilities
1. Participate in staff meetings.
2. Attend Billing trainings as needed.
3. Perform other duties and responsibilities as assigned by management.
Working Conditions
Indoors, in the clinic office and in the administrative office.
Working Hours
Normally 7:30 a.m. to 4:30 p.m., Monday through Friday. Some evening and weekend work may be required; dependent on position duties and responsibilities.
Equipment Use
Computer, copier, telephone, fax machine, and other standard office equipment.
Mental Demands
Duties require observing and reporting client health care needs and services; dealing courteously and tactfully with clients, service providers, coworkers, and Native Hawaiian Community; working under occasional pressure and deadlines; following instruction in company policies and procedures; complying with KOM Code of Ethics.
Communication Demands
Requires strong verbal and written communication, which entails preparation of oral and written reports, memos, and other communications in a clear, concise, and professional manner; taking accurate phone messages; explaining balances on patient statements, able to understand and insurance claim denials and take corrective actions.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 25 pounds; assist clients with mobility problems. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
Qualification Requirements
Knowledge, Skills and Abilities Requirements
Demonstrated knowledge of Native Hawaiian cultural values and practices in the delivery of health care services.
Excellent knowledge of community, health, and human service agency resources.
Knowledge of technology and automation.
Demonstrated ability to plan and implement strategies to meet clients’ clinical needs.
Excellent problem solving, organizational, detail oriented and time management skills.
Excellent interpersonal skills.
Demonstrated ability to coordinate service provisions for clients.
Ability to maintain composure under time restraints.
Ability to maintain accountability and confidentiality.
Ability to prioritize tasks and demonstrate high integrity.
Other Requirements
Have a valid driver’s license and use of a personal vehicle for work with proof of adequate automobile insurance coverage. May use company vehicle for business of the organization.
Driver’s abstract without any moving violations within the past 3 years
Valid tuberculosis clearance within one (1) year.
Valid COVID Vaccination card at the time of application
Current CPR and First Aid for Healthcare Providers certification.
Education and Experience Requirements
High School Diploma or Equivalent
At least two (2) years’ experience of billing experience or completion of a college degree in Medical office and billing.
Insurance Verification (2) years.
Prefer proficient knowledge and ability to utilize Windows 10 Pro computer system and Microsoft Office 365 applications.
Any combination of education and experience that would provide the necessary knowledge, skills and abilities to perform the essential functions of this position.
ECW experience preferred
To be considered for employment, interested applicants must submit a resume to:
hpila@keolamamo.org or fax at 808-848-8001.