Full-Time

Medical Billing Specialist I or II

Posted on 9/26/2024

Oklahoma State Government

Oklahoma State Government

201-500 employees

Manages state-funded health care costs and quality

Government & Public Sector
Healthcare

Compensation Overview

$38.8k - $45.3kAnnually

Entry, Junior, Mid

Oklahoma, USA

Eligible for Telework / Hybrid Telework, subject to OSDH policy and supervisor’s discretion.

Category
Healthcare Administration & Support
Medical, Clinical & Veterinary
Requirements
  • 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.
  • 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.
Responsibilities
  • Review rejected claims in the clearinghouse for errors; determine steps to resolve the errors; and take corrective action for claims resubmission.
  • Review denied claims in the clearinghouse and in Medicaid UCE files 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.
  • Respond to inquiries in the Medical Billing inbox and that arise via phone in a professional and timely manner.
  • Attend trainings to maintain and improve medical billing knowledge and skills.
  • Assist with provider credentialing and access to provider portals.
Oklahoma State Government

Oklahoma State Government

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The Oklahoma Health Care Authority (OHCA) manages the costs of health care funded by the state and federal government in Oklahoma. It ensures that the health care services provided meet acceptable standards while also focusing on creating a positive experience for citizens who rely on these services. OHCA's main functions include purchasing health care services, analyzing ways to improve accessibility and quality, and building partnerships to enhance health outcomes for Oklahomans. The agency serves low-income individuals, families, and other vulnerable groups, emphasizing cost control and quality assurance in the public health sector. Unlike private health care providers, OHCA operates with a focus on fiscal responsibility, using state and federal funds to provide necessary health care services. The goal of OHCA is to improve the health of Oklahomans by ensuring that they have access to quality health care services.

Company Stage

Grant

Total Funding

$4.1M

Headquarters

Kansas City, Missouri

Founded

1953

Growth & Insights
Headcount

6 month growth

0%

1 year growth

0%

2 year growth

0%
Simplify Jobs

Simplify's Take

What believers are saying

  • Telehealth expansion offers cost-effective healthcare for rural and underserved areas.
  • AI integration in healthcare can improve patient outcomes and reduce costs.
  • Medicaid expansion increases healthcare access for low-income populations.

What critics are saying

  • DDS waitlist reduction may strain OHCA's resources and budget.
  • Interim directors in state agencies may affect OHCA's inter-agency collaborations.
  • Resignation of key leaders could disrupt OHCA's healthcare initiatives and partnerships.

What makes Oklahoma State Government unique

  • OHCA focuses on cost control and quality assurance in state-funded healthcare.
  • The agency serves diverse clients, including low-income and vulnerable populations.
  • OHCA fosters strategic partnerships to improve health outcomes in Oklahoma.

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