Overview Prepare and submit billing data for technical and professional, primary, and secondary medical claims to insurance companies. Follow up on unpaid, rejected, or denied claims. Resolve issues to resubmit claims in error. File appeals on denials when necessary. Correct patient insurance information as needed. Generate reports and process request for information. Report problems to appropriate department supervisor. Qualifications Health Claims Biller I Non-Certified EDUCATIONAL REQUIREMENT High School diploma or general education degree (GED). EXPERIENCE REQUIREMENTS. At least six (6) months of experience in a related field. COMPUTER SKILLS To perform this job successfully, an individual should have knowledge of Accounting software; Database software; Internet software; Spreadsheet software; and Word Processing software. CERTIFICATES, LICENSES, REGISTRATION: Must possess a valid driver's license with a driving history verified through a motor vehicle report that meets requirements for Cherokee Nation underwriting rating. OTHER QUALIFICATIONS The employee must not be and will 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. Health Claims Biller II Non-Certified EDUCATIONAL REQUIREMENT High School diploma or general education degree (GED); no exceptions. EXPERIENCE REQUIREMENTS. At least two (2) years experience in a related field. COMPUTER SKILLS To perform this job successfully, an individual should have knowledge of Accounting software; Database software; Internet software; Spreadsheet software; and Word Processing software. CERTIFICATES, LICENSES, REGISTRATION: Must possess a valid driver's license with a driving history verified through a motor vehicle report that meets requirements for Cherokee Nation underwriting rating. OTHER QUALIFICATIONS The employee must not be and will 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. Health Claims Biller I Certified EDUCATIONAL REQUIREMENT High school diploma or general education degree (GED) and at least one (1) year of specialized training or education. EXPERIENCE REQUIREMENTS No additional experience. COMPUTER SKILLS An individual should have knowledge of, Accounting software; Database software; Internet software; Spreadsheet software; and Word Processing software. CERTIFICATES, LICENSES, REGISTRATIONS Credential of Certified Professional Biller (CPB) preferred, or any credential in medical coding from a nationally recognized accredited agency, i.e. American Academy of Professional Coder, (AAPC) or American Health Information Management Association (AHIMA). Must possess a valid driver's license with a driving history verified through a motor vehicle report that meets requirements for Cherokee Nation underwriting rating. OTHER QUALIFICATIONS The employee must not be and will 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). Must be able to operate standard office equipment. Knowledge of current ICD, CPT, and HCPCS coding guidelines and Medical Terminology. Good understanding of third party insurance requirements and billing guidelines. Familiarity with CMS UB04 and 1500 billing forms. Knowledge of electronic health records recommended. Educated on and compliant with HIPAA regulations; maintain strict confidentiality of client information. Health Claims Biller II Certified EDUCATIONAL REQUIREMENT High school diploma or general education degree (GED) and at least one (1) year of specialized training or education. EXPERIENCE REQUIREMENTS An additional one (1) year of full-time paid experience as a certified health claims biller; or three (3) years of full-time paid experience as a non-certified health claims biller. COMPUTER SKILLS An individual should have knowledge of, Accounting software; Database software; Internet software; Spreadsheet software; and Word Processing software. CERTIFICATES, LICENSES, REGISTRATIONS Credential of Certified Professional Biller (CPB) preferred, or any credential in medical coding from a nationally recognized accredited agency, i.e. American Academy of Professional Coder, (AAPC) or American Health Information Management Association (AHIMA). Must possess a valid driver's license with a driving history verified through a motor vehicle report that meets requirements for Cherokee Nation underwriting rating. OTHER QUALIFICATIONS The employee must not be and will 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). Must be able to operate standard office equipment. Knowledge of current ICD, CPT, and HCPCS coding guidelines and Medical Terminology. Good understanding of third party insurance requirements and billing guidelines. Familiarity with CMS UB04 and 1500 billing forms. Knowledge of electronic health records recommended. Educated on and compliant with HIPAA regulations; maintain strict confidentiality of client information. Health Claims Biller III Certified EDUCATIONAL REQUIREMENT High school diploma or general education degree (GED) and at least one (1) year of specialized training or education. EXPERIENCE REQUIREMENTS An additional three (3) years of full-time paid experience as a non-certified health claims biller. COMPUTER SKILLS An individual should have knowledge of, Accounting software; Database software; Internet software; Spreadsheet software; and Word Processing software. CERTIFICATES, LICENSES, REGISTRATIONS Credential of Certified Professional Biller (CPB) preferred, or any credential in medical coding from a nationally recognized accredited agency, i.e. American Academy of Professional Coder, (AAPC) or American Health Information Management Association (AHIMA). Must possess a valid driver's license with a driving history verified through a motor vehicle report that meets requirements for Cherokee Nation underwriting rating. OTHER QUALIFICATIONS The employee must not be and will 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). Must be able to operate standard office equipment. Knowledge of current ICD, CPT, and HCPCS coding guidelines and Medical Terminology. Good understanding of third party insurance requirements and billing guidelines. Familiarity with CMS UB04 and 1500 billing forms. Knowledge of electronic health records recommended. Educated on and compliant with HIPAA regulations; maintain strict confidentiality of client information. PHYSICAL DEMANDS While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk; climb or balance and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, color vision and ability to adjust focus. WORK ENVIRONMENT The noise level in the work environment is usually moderate.