Medical Records Biller IV- Lead

About the role

Koniag Advisory Business Solutions, LLC, a Koniag Government Services company, is seeking a Medical Records Biller IV Lead to support KABS and our government customer in Oklahoma, OKC. This position requires the candidate to be able to obtain a Public Trust. This position is covered under the Service Contract Act. We offer competitive compensation and an extraordinary benefits package including health, dental and vision insurance, 401K with company matching, paid holidays, paid Vacation, paid sick leave and more.

Responsibilities

• Billing Program - Oversees preparation and submission of complex outpatient and inpatient claims to third-party payers, intermediaries, and responsible parties in accordance with required timelines and internal controls.
• Reviews daily system reports and monitors claim inventory to ensure timely processing, export, and transmission.
• Responds to post-payment reviews, exclusions, denials, and appeals and assists with medical reviews and claim-level audit activity.
• Ensures daily billing productivity reporting is accurate and that unbillable claims are identified, documented, and elevated appropriately.
• Maintains current knowledge of payer guidance, listserv updates, policy changes, and continuing education resources.
• Verification Data - Performs advanced review of medical records to validate diagnoses, dates of service, provider signatures, attestation requirements, and documentation needed to support claim submission.
• Guides eligibility verification and insurance-identification review activities for complex cases and supports resolution of coverage issues.
• Supports preparation and compilation of authorizations, benefits assignments, release forms, and pre-certification documents needed for payer approval and claim support.
• Refers appropriate patients to Benefits Coordination or Social Services and helps staff navigate complicated eligibility situations.
• Claims Process / Accounts Receivable - Reviews patient records and billing data for outpatient and inpatient services and supports accurate sequencing of ICD, CPT, and HCPCS codes used in billing.
• Safeguards provider documentation supporting billed diagnoses, procedures, and E&M levels and resolves discrepancies affecting reimbursement.
• Maintains corrective action information from fiscal intermediaries and payers and shares findings with appropriate staff for reconsideration or appeal.
• Prepares and reviews UB-04, CMS-1500, and other required forms for accuracy, completeness, and regulatory compliance.
• Leads correction of rejected or suspended claims and supports collection activity by maintaining accurate documentation in RPMS or other approved systems.
• Affirms daily billing procedures, status tracking methods, and claim follow-up controls.
• Benefits Coordination Function - Communicates with DHHS operational personnel, fiscal intermediary staff, claims processing personnel, Social Security Administration, state medical offices, PRO personnel, and Service Unit staff to resolve challenging billing and systems issues.
• Maintains communication with first-line billing leadership to support proper use of funds collected from third-party insurance under applicable Indian Health Care Improvement Act requirements.
• Responds to ad hoc requests by defining information needs, structuring search strategies, and retrieving required data from approved systems.
• Determines when data reconstruction, reruns, or restart actions may be needed to better align systems processing with billing requirements.
• Administrative Support - Acts as a lead contact for complex claims-processing questions and recurring billing problems and recommends changes in methods or procedures to improve outcomes.
• Maintains confidentiality of Alternate Resources claims and medical records and ensures staff follow disclosure limits under IHS policy.
• Helps prepare responses to inquiries elevated by facility leadership and follows up to ensure timely resolution.
• Mentors new staff and provides technical guidance to Medical Biller III personnel as assigned.

Requirements

• High school diploma or equivalent plus 5+ years of progressively responsible medical billing, claims processing, patient accounts, or revenue cycle experience; or an associate’s or bachelor’s degree in Health Information Management, Medical Billing and Coding, Business, or related field with 2+ years of progressively complex experience.
• Completion of an accredited Medical Billing, Medical Coding, Health Information Management, or related program preferred.
• Advanced knowledge of outpatient and inpatient claim preparation, denial management, payer requirements, UB-04 and CMS-1500 billing, and accounts receivable follow-up.
• Strong working knowledge of ICD, CPT, and HCPCS coding as used in billing support functions.
• Experience with audits, appeals, post-payment review response, and payer communication.
• Proficiency with EHRs, RPMS or comparable systems, billing platforms, and reporting tools.
• Strong independent judgment, attention to detail, and analytical capability.
• Experience working in Indian Health Service.
• Expertise in Medicare, Medicaid, and commercial insurance billing requirements and reimbursement practices.
• Ability to mentor new staff and build cohesive working relationships with team members.
• Familiarity with HIPAA regulations and healthcare compliance.
• Possess sufficient initiative, interpersonal relationship skills, and social sensitivity such that he/she can relate constructively to Native American communities.

Qualifications

• You must be able to obtain and maintain a favorable Tier II background investigation determination, as required by the Indian Health Service (IHS), as a condition of access to IHS facilities, systems, and data.
• You must successfully complete all required fingerprinting, identity proofing, credentialing, badge, and access steps.
• You must complete required privacy, HIPAA, and IT security training within required timeframes and maintain current status thereafter.
• You must comply with all IHS, HHS, facility, and company privacy, confidentiality, records management, and cybersecurity requirements.
• You must protect PHI and other sensitive information in both paper and electronic form using required administrative, technical, and physical safeguards.
• You must immediately report suspected privacy breaches, improper disclosures, security incidents, malware events, lost devices, or unauthorized access.
• You must use only authorized systems, accounts, devices, software, and remote-access methods.
• You must maintain workstation, password, and badge security at all times.
• You must be able to support periodic access reviews, audits, and compliance checks.

Benefits

• Competitive compensation.
• Extraordinary benefits package including health, dental and vision insurance, 401K with company matching.
• Paid holidays, paid Vacation, paid sick leave and more.
• Security and Compliance Requirements - Must be able to obtain and maintain a favorable Tier II background investigation determination, as required by IHS.Must successfully complete all required fingerprinting, identity proofing, credentialing, badge, and access steps.Must complete required privacy, HIPAA, and IT security training within required timeframes and maintain current status thereafter.Must comply with all IHS, HHS, facility, and company privacy, confidentiality, records management, and cybersecurity requirements.Must protect PHI and other sensitive information in both paper and electronic form using required administrative, technical, and physical safeguards.Must immediately report suspected privacy breaches, improper disclosures, security incidents, malware events, lost devices, or unauthorized access.Must use only authorized systems, accounts, devices, software, and remote-access methods.Must maintain workstation, password, and badge security at all times.Must be able to support periodic access reviews, audits, and compliance checks.