This position is located in the Business Office of the Claremore Indian Hospital, Oklahoma Area. The primary purpose of this position is to abstract and interpret coding data from patient health records, prepare and submit properly executed outpatient and inpatient third party claims on a timely basis to third party payers and responsible parties, and correct and re-bill accounts previously submitted. The incumbent will report to the Business Office Manager.

Duties

Respond to third party requirements on post-payment reviews, exclusions, denials, and appeals. Assign and sequence a variety of codes including but not limited to ICD/CPT/HCPCS codes based on the medical record analysis. Prepare and submit claims to third party payers, intermediaries or responsible parties within the allowed time frame of the Third Party Internal Controls Policy for outpatient and inpatient claims. Perform qualitative and quantitative analysis by reviewing the medical record to ensure it contains proper documentation in accordance with regulations. Initiate the referral of potentially third party eligibility patients to the Benefits Coordinator or Social Services Department for assistance in obtaining health insurance under these programs.

Requirements

Qualifications

To qualify for this position, your resume must state sufficient experience and/or education, to perform the duties of the specific position for which you are applying. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community; social). You will receive credit for all qualifying experience, including volunteer and part time experience. You must clearly identify the duties and responsibilities in each position held and the total number of hours per week. MINIMUM QUALIFICATIONS: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: GS-07: One (1) year of specialized experience equivalent to at least the GS-06 level in the Federal service that has equipped me with the particular knowledge, skills, and abilities to successfully perform the duties of the position. Experience includes: Making final determination that the record is complete, accurate, and reflects sufficient data to justify the diagnosis; submitting medical billing claims; correcting billing transactions; following up on Medicare and Medicaid denials; and providing technical assistance pertaining to coding and medical billing. Time In Grade Federal employees in the competitive service are also subject to the Time-In-Grade Requirements: Merit Promotion (status) candidates must have completed one year of service at the next lower grade level. Time-In-Grade provisions do not apply under the Excepted Service Examining Plan (ESEP). You must meet all qualification requirements within 30 days of the closing date of the announcement.

Education

There are no education requirements.

Contacts

• Address Claremore Service Unit 101 S Moore Claremore, OK 74017 US
• Name: Shiron Musick
• Phone: 918-342-6681
• Email: [email protected]