The Program Billing Specialist works with clinical staff and program managers to ensure services are authorized, documented, billed, and paid in a timely and effective manner. This role serves as the primary billing contact for assigned programs and helps maintain accurate billing, documentation, and reimbursement processes.
Key responsibilities include:
- Enter billing data from clinical documentation to generate accurate charges in accordance with funding source requirements.
- Review incoming clinical documentation for completeness, accuracy, and compliance with timeliness and payer-specific standards.
- Collaborate with management to ensure electronic billing charges and corrections are completed on time to support maximum reimbursement.
- Research claim denials, determine validity, and adjust and resubmit claims when appropriate.
- Input and maintain billing-related data in billing systems according to established procedures and controls.
- Maintain required performance data and billing/collections metrics.
- Resolve eligibility and billing exceptions in the 271 eligibility file and 837 billing file before the next billing cycle.
- Identify and correct CDC errors in PICIS and support staff with CDC status and corrective actions.
- Ensure required eligibility information is obtained and updated to support accurate billing and reimbursement.
- Communicate barriers to timely and accurate billing to appropriate management.
- Follow HIPAA and other applicable state, federal, and agency confidentiality regulations.
- Perform other duties as assigned.
Requirements & Qualifications
Education and experience:
- High school diploma or equivalent required.
- Minimum of 1 year of responsible administrative experience.
- Knowledge of Medicare and Medicaid billing required.
Skills and abilities:
- Ability to organize and manage large volumes of documentation.
- Ability to comprehend and interpret verbal and written instructions.
- Proficiency in Microsoft Office Suite or equivalent software.
- Intermediate computer skills.
- Strong verbal and written communication skills.
- Strong interpersonal skills and ability to work effectively with employees at all levels.
- Ability to collaborate professionally with diverse staff and stakeholders.
Other requirements:
- Must complete required NorthCare training within 30 days of employment.
- Must have a current TB test within 12 months prior to employment or obtain one within 30 days of employment.
- Ability to sit for extended periods while working at a computer.
- Ability to bend, stoop, climb stairs, and move throughout facilities.
- Ability to reach upward and downward for filing.
- Finger dexterity sufficient for keyboarding and other administrative tasks.
Location
Oklahoma City, Oklahoma, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
No
Posted
1 month ago
Browse More Jobs