Medical Billing Technician I/II/III - Echo Cliffs Health Center

Navajo Preference Employment Act

In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference.

Overview

POSITION SUMMARY

The Medical Billing Technician I/II/III is responsible for accurate, timely, and compliant medical claims billing and related revenue cycle activities for hospital, outpatient, ambulatory, dental, pharmacy, and other assigned clinical service lines. The position supports the full claim lifecycle from account review, billing validation, claim generation, claim editing, electronic submission, payer rejection correction, rebilling, denial follow-up support, and coordination of information needed to secure appropriate reimbursement from third-party payers and responsible parties.

The incumbent validates billing information against documentation, coding, authorization, payer requirements, utilization review determinations, charge capture, patient demographics, insurance coverage, and other account-level data. The role requires strong attention to detail, sound judgment, knowledge of payer billing rules, and the ability to collaborate with Patient Access, Health Information Management, Coding, Utilization Review, Clinical Departments, Compliance, Provider Enrollment, Finance, and payer representatives.

This position is expected to support modern hospital and ambulatory billing operations, including use of electronic health record and claim-editing systems. Preferred experience includes Altera Sunrise EHR SCM/SFM workflows and Optum Assurance claim editing, work queue management, and pre-claim validation processes. The position contributes directly to compliant reimbursement, denial prevention, clean claim performance, cash acceleration, and the financial sustainability of Echo Cliffs Health Center.

Qualifications

NECESSARY QUALIFICATIONS

Education:

Technician I: Must have a High School diploma or GED equivalent.

Technician II: Must have a Medical Billing and Coding Certificate or certification in a related healthcare business, revenue cycle, billing, coding, or administrative field.

Technician III: Must have an Associate's Degree or higher in Business Administration or Hospital Administration or a related field.

Experience:

Technician I: Minimum of one (1) year of experience related to medical, dental, pharmacy, hospital, ambulatory, patient access, medical billing, claims processing, coding, or revenue cycle operations. Knowledge of medical terminology, anatomy, physiology, and basic payer billing concepts is required.

Technician II: Minimum of three (3) years of progressively responsible experience in medical, dental, pharmacy, hospital, ambulatory, billing operations, coding, patient access, payer follow-up, claim correction, or related revenue cycle functions. Must demonstrate working knowledge of payer requirements, claim forms, coding sets, and claim submission processes.

Technician III: Five (5) or more years of advanced experience in medical claims billing, hospital and ambulatory revenue cycle operations, denial/rejection correction, payer billing requirements, reimbursement workflows, and account research. Must demonstrate in-depth knowledge of billing compliance, claim edits, payer rules, and system-based claim resolution.

Other Skills and Abilities:

A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas:

• Positive working relationships with others.
• Possession of high ethical standards and no history of substantiated complaints related to integrity, confidentiality, or professional conduct.
• Reliable and dependable; reports to work as scheduled without excessive absences.
• Completion of and above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the job.
• Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers.
• Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC.
• Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading, or incomplete information, as determined by TCRHCC.

MENTAL AND PHYSICAL EFFORT

Physical:

The work is primarily sedentary. The employee must have the ability to sit for prolonged periods and occasionally stand, walk, drive, bend, climb, kneel, crouch, twist, maintain balance, and reach. Must have the ability to lift, push, and pull over 100 pounds occasionally. Sensory requirements include prolonged telephone and computer use, frequent far, near, and color vision, depth perception, seeing fine details, hearing normal speech, and hearing overhead pages. Must have ability for prolonged keyboard use, both-hand manipulation, frequent simple and firm grasping, and fine manipulation.

Mental:

Exercises initiative and judgment in deviating from existing department or corporation practices to resolve billing issues and concerns. Work is reviewed for conformance to policies, procedures, compliance requirements, and billing practices. Must have the ability to sustain prolonged concentration; work independently; cope with high levels of stress; make decisions under pressure; handle multiple priorities in stressful situations; demonstrate patience; adapt to shift work; work in close or crowded areas; occasionally cope with anger, fear, or hostility of others in a calm way; manage altercations; and maintain flexibility, including accepting a flexible schedule to meet unit needs.

Environmental:

May occasionally be exposed to infectious disease, chemical agents, dust, fumes, gases, extremes in temperature or humidity, hazardous or moving equipment, unprotected heights, and loud noises.

IMPACT

The funds collected through accurate billing, claim submission, denial prevention, and account resolution are used by the corporation for daily operations, capital projects, planning purposes, and core services that support the overall objective of elevating the health status of Indian beneficiaries. The successful efforts of the incumbent directly impact funds collected, reimbursement performance, compliance risk, patient account accuracy, and the financial viability of the medical center.

Responsibilities

ESSENTIAL FUNCTIONS:

Technician I:

• Receives, reviews, and examines accounts and alternate resources of claims to ensure claim readiness, including completeness of supporting documents, payer information, utilization review certifications, authorizations, referrals, and other account-specific requirements.
• Verifies accuracy of patient account number, patient demographics, insurance information, claim amount, payer sequencing, authorization status, responsible party information, and billing documentation before claim submission.
• Reviews medical record and account documentation to identify ICD-10-CM, CPT, HCPCS, revenue code, modifier, charge, payer, and other billing data necessary for accurate and compliant claim preparation.
• Identifies documentation gaps, coding concerns, missing charges, duplicate charges, demographic errors, insurance mismatches, authorization concerns, or payer-specific billing issues and routes them to the appropriate department or individual for correction.
• Coordinates with attending physicians, clinical departments, laboratory, radiology, pharmacy, coding, utilization review, patient access, compliance, and finance to obtain information needed for accurate, complete, and compliant billing.
• Reviews system-generated billing reports, claim queues, worklists, edits, suspended claims, rejected claims, and account follow-up items on a daily basis to identify accounts ready for billing or requiring correction.
• Prepares and submits clean claims to third-party payers, intermediaries, or responsible parties within established organizational timelines after all required billing information becomes available.
• Resolves claim errors, payer rejections, suspended claims, returned claims, billing edits, and previously submitted claim corrections in accordance with policy, payer guidelines, and compliance expectations.
• Uses assigned systems to document billing actions, account notes, payer responses, claim corrections, escalation steps, and follow-up activity accurately and timely.
• Maintains working knowledge of assigned payer billing rules, claim submission requirements, timely filing standards, authorization rules, medical necessity requirements, and payer-specific billing updates.
• Supports hospital and ambulatory billing operations across assigned service lines, including but not limited to emergency, outpatient, ancillary, specialty, dental, pharmacy, recurring, and other assigned services.
• Follows all applicable privacy, HIPAA, compliance, False Claims Act, organizational billing, and payer requirements when reviewing, correcting, and submitting claims.
• Ensures proper PPE is worn while on duty when required by organizational policy, including but not limited to face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, and eye or face shield, as applicable.
• Completes donning and doffing tasks in a safe and acceptable method and discards used PPE accordingly in accordance with current organizational and public health guidance.
• Completes task training for routine cleaning and decontamination processes for surfaces contaminated by a communicable disease to support a safe environment and a high level of patient, visitor, employee, and external customer satisfaction.
• Performs other duties and responsibilities as assigned.

Technician II/III:

• Performs all duties assigned to Technician I and serves as a resource for complex billing, claim correction, payer issue resolution, account research, and system workflow questions.
• Performs super-user duties, including researching and troubleshooting billing system issues, assisting with new system and process implementations, supporting system upgrades and testing, and completing required system training certifications.
• Supports Altera Sunrise SCM/SFM billing workflows, including claim generation, account review, charge validation, billing work queues, payer/plan configuration concerns, account edits, and system-based claim troubleshooting, as applicable to assigned responsibilities.
• Uses Optum Assurance or comparable claim editing tools to identify, research, correct, and escalate claim edits, payer edits, front-end billing issues, claim scrubber failures, and denial-prevention opportunities.
• Analyzes claim rejection, denial, and edit trends to assist leadership in identifying root causes, workflow gaps, payer issues, training needs, charge capture concerns, and revenue cycle improvement opportunities.
• Assists with development, testing, and validation of billing workflows, claim edits, payer rule updates, system upgrades, downtime recovery processes, recurring account billing, and other revenue cycle initiatives.
• Performs in-depth case work related to workers' compensation, motor vehicle accidents, liability claims, third-party recovery, attorney correspondence, liens, settlement follow-up, and related documentation from account opening through closure.
• Communicates closely with patients, employees, employers, payers, attorneys, county courthouses, and all other parties involved in assigned case work, including submission and release of liens as required.
• Performs negotiation and account resolution activities with third-party payers, intermediaries, attorneys, and responsible parties within the assigned scope and organizational policy.
• Supports training and mentoring of lower-level staff by sharing billing knowledge, reviewing common errors, explaining payer requirements, and reinforcing clean claim and compliance expectations.
• Assists management with quality review, productivity monitoring, special projects, claim backlog reduction, denial prevention, payer follow-up initiatives, and revenue cycle performance improvement activities.
• Performs other duties and responsibilities as assigned.