State of Oklahoma
Medical Billing Specialist I or II
State of Oklahoma, Oklahoma City, Oklahoma, United States, 73116
Job Title
Medical Billing Specialist I or II – State of Oklahoma
3 days ago – Be among the first 25 applicants
Location Central Office
Salary Up to $53,600.00, based on education and experience
Employment Status Full time
Work Schedule Monday to Friday, 8:00 am to 5:00 pm
Position Description The Medical Billing Specialist is responsible for the outpatient billing cycle for client services rendered at the county health departments. Reviews and submits medical claims to third-party payers. Researches and determines appropriate actions for correcting rejected and denied medical claims. Reconciles claims and posts any adjustments, transfers, and/or payments to patient accounts. Assists in identifying medical billing issues that require further attention.
Level II: At this level of work, may assist in training county health department staff on various aspects of medical billing, and is involved in quality improvement.
Position Responsibilities/Essential Functions
Review/scrub claims prior to submission to improve clean claim submission rate.
Review rejected claims for errors; determine steps to resolve the errors; and take corrective action for claims resubmission.
Review denied claims for denial reasons; determine steps necessary for successful claims submission based on those reasons according to payer contracts and requirements; and take corrective action to resubmit claims for maximum reimbursement.
Provide centralized facilitation and monitoring of requests for prior authorizations for services when required by payer contracts.
Enter payment and non-payment data from remittance advice (RA) to reconcile claims in the billing system, which includes identifying and documenting the appropriate adjustment or non-payment reason; file paper RAs.
Identify and troubleshoot anomalies and possible errors in the claims process and communicate verbally and in writing to supervisor for further analysis.
Communicate and follow up with county health department staff to assist in correcting claims at the client level.
Participates in audits and assists with internal quality improvement initiatives related to billing and coding.
Respond to inquiries in the Medical Billing inbox and inquiries that arise via phone in a professional and timely manner.
Attend payer trainings, updates, and webinars and review any guidance to maintain and improve medical billing knowledge and skills.
May assist with provider credentialing and access to provider portals.
Level II: May be involved in developing training materials and delivering training to OSDH staff.
Being present in the office is an essential function of this job.
Other duties as assigned.
Other Duties
Demonstrates knowledge of and supports mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
Works effectively in team environment, participating and assisting their peers.
Minimum Qualifications
Level I:
Two (2) or more years of experience in a medical or behavioral health office or an associate’s degree in a related field or equivalent combination of education and experience. Substituting six semester hours completed at an accredited college or university for each six months of the required experience or the completion of a vocational training course in medical billing.
Level II:
Four or more years of experience in medical or behavioral health office or a bachelor’s degree in a related field and one year of experience or equivalent combination of education and experience. Substituting six semester hours completed at an accredited college or university for each six months of the required experience or the completion of a vocational training course in medical billing.
Preferred Qualification
Professional Medical Billing certification.
Application Requirements
If education, certification or licensure is required to meet qualifications, applicants must provide documentation at the time of application.
All applicants are subject to a background check and must be legally authorized to work in the United States without visa sponsorship.
Valued Knowledge, Skills And Abilities
Able to work independently with minimal guidance upon training.
Proficient in electronic health record systems, medical billing software, clearinghouses, and payer portals.
Experience with insurance benefit verification, prior authorization/referral guidelines, coding and data entry experience.
Strong written and verbal communication skills to effectively resolve claim issues with payers and provide guidance to county staff.
Knowledge of CPT, HCPCS, and ICD-10-CM coding principles.
Ability to interpret Explanation of Benefits and Remittance Advice documents, including denial codes and their appropriate resolution.
Must be able to analyze problems, do research, and propose solutions.
Knowledge of Medicare, Medicaid and private third-party insurance uniform billing process and procedures.
Experience with public health medical billing is a plus.
Physical Demands And Work Environment Work is typically performed in an office setting with climate-controlled settings and exposure to moderate noise levels. While performing the duties of the job, employees are required to talk, stand, walk, and reach with hands and arms; carry light items. This position requires long periods of sitting and daily use of computers and phones. Applicants must be willing to perform all job-related travel associated with this position. Being present at the office is an essential function of the job.
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3 days ago – Be among the first 25 applicants
Location Central Office
Salary Up to $53,600.00, based on education and experience
Employment Status Full time
Work Schedule Monday to Friday, 8:00 am to 5:00 pm
Position Description The Medical Billing Specialist is responsible for the outpatient billing cycle for client services rendered at the county health departments. Reviews and submits medical claims to third-party payers. Researches and determines appropriate actions for correcting rejected and denied medical claims. Reconciles claims and posts any adjustments, transfers, and/or payments to patient accounts. Assists in identifying medical billing issues that require further attention.
Level II: At this level of work, may assist in training county health department staff on various aspects of medical billing, and is involved in quality improvement.
Position Responsibilities/Essential Functions
Review/scrub claims prior to submission to improve clean claim submission rate.
Review rejected claims for errors; determine steps to resolve the errors; and take corrective action for claims resubmission.
Review denied claims for denial reasons; determine steps necessary for successful claims submission based on those reasons according to payer contracts and requirements; and take corrective action to resubmit claims for maximum reimbursement.
Provide centralized facilitation and monitoring of requests for prior authorizations for services when required by payer contracts.
Enter payment and non-payment data from remittance advice (RA) to reconcile claims in the billing system, which includes identifying and documenting the appropriate adjustment or non-payment reason; file paper RAs.
Identify and troubleshoot anomalies and possible errors in the claims process and communicate verbally and in writing to supervisor for further analysis.
Communicate and follow up with county health department staff to assist in correcting claims at the client level.
Participates in audits and assists with internal quality improvement initiatives related to billing and coding.
Respond to inquiries in the Medical Billing inbox and inquiries that arise via phone in a professional and timely manner.
Attend payer trainings, updates, and webinars and review any guidance to maintain and improve medical billing knowledge and skills.
May assist with provider credentialing and access to provider portals.
Level II: May be involved in developing training materials and delivering training to OSDH staff.
Being present in the office is an essential function of this job.
Other duties as assigned.
Other Duties
Demonstrates knowledge of and supports mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
Works effectively in team environment, participating and assisting their peers.
Minimum Qualifications
Level I:
Two (2) or more years of experience in a medical or behavioral health office or an associate’s degree in a related field or equivalent combination of education and experience. Substituting six semester hours completed at an accredited college or university for each six months of the required experience or the completion of a vocational training course in medical billing.
Level II:
Four or more years of experience in medical or behavioral health office or a bachelor’s degree in a related field and one year of experience or equivalent combination of education and experience. Substituting six semester hours completed at an accredited college or university for each six months of the required experience or the completion of a vocational training course in medical billing.
Preferred Qualification
Professional Medical Billing certification.
Application Requirements
If education, certification or licensure is required to meet qualifications, applicants must provide documentation at the time of application.
All applicants are subject to a background check and must be legally authorized to work in the United States without visa sponsorship.
Valued Knowledge, Skills And Abilities
Able to work independently with minimal guidance upon training.
Proficient in electronic health record systems, medical billing software, clearinghouses, and payer portals.
Experience with insurance benefit verification, prior authorization/referral guidelines, coding and data entry experience.
Strong written and verbal communication skills to effectively resolve claim issues with payers and provide guidance to county staff.
Knowledge of CPT, HCPCS, and ICD-10-CM coding principles.
Ability to interpret Explanation of Benefits and Remittance Advice documents, including denial codes and their appropriate resolution.
Must be able to analyze problems, do research, and propose solutions.
Knowledge of Medicare, Medicaid and private third-party insurance uniform billing process and procedures.
Experience with public health medical billing is a plus.
Physical Demands And Work Environment Work is typically performed in an office setting with climate-controlled settings and exposure to moderate noise levels. While performing the duties of the job, employees are required to talk, stand, walk, and reach with hands and arms; carry light items. This position requires long periods of sitting and daily use of computers and phones. Applicants must be willing to perform all job-related travel associated with this position. Being present at the office is an essential function of the job.
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