Cherokee Nation is seeking a Health Claims Biller I Non-Certified to join our team. In this role, you will prepare and submit billing data for technical and professional, primary, and secondary medical claims to insurance companies. Your focus will be on accurate submission and diligent follow-up to resolve unpaid, rejected, or denied claims.

What You'll Do

Bill and rebill institutional and professional medical claims accurately and timely.
Document all conversations and actions related to resolving institutional and professional medical claims issues.
Prepare 'timeline' appeals and/or provider dispute forms, including requesting medical records.
Verify patient benefits eligibility and coverage and perform patient account data entry maintenance.
Manage denial and insurance follow-up and create appeal letters with appropriate details.
Navigate through various systems while on the phone.
Respond to correspondence from insurance carriers in a timely manner.
Read and interpret insurance explanation of benefits.
Contact third-party payers to determine claim status for institutional and professional medical claims.
Interpret NCCI edits regarding diagnosis and procedure coding rules and payer guidelines.
Maintain the privacy of patients and their protected health information (PHI); following HIPAA regulations.
Generate reports and process requests for information.
Report problems to appropriate department supervisor.

What We're Looking For

High School diploma or general education degree (GED).
At least six (6) months of experience in a related field.
Must possess a valid driver's license with a driving history meeting Cherokee Nation underwriting requirements.
Must not be under sanction by the United States Department of Health and Human Services Office of the Inspector General (OIG) or by the General Services Administration (GSA) or listed on the OIG's Cumulative Sanction Report, or the GSA's List of Excluded Providers, or listed on the OIG's List of Excluded Individuals/Entities (LEIE).
Educated on and compliant with HIPAA regulations; maintain strict confidentiality of client information.