Medical Billing/Coding Specialist

Medical Billing/Coding Specialist

Bethany Children's Health Center - Bethany, OK 73008

Overview

Job Shift Administrative

Description

Job Purpose

The Billing Specialist is responsible for the accurate and timely billing of inpatient services; as well as outpatient clinic services across multiple specialties, including therapy, medical, and ancillary services. This role ensures claims are coded, validated, and submitted in compliance with payer-specific rules, with a strong focus on high-volume outpatient encounters, denial prevention, and revenue cycle optimization. While supporting overall billing operations, this position is primarily focused on outpatient workflows and payer requirements.

Duty - Percent of Time

Primary Outpatient Billing Functions

• Prepare, review, and submit outpatient clinic claims for multiple service lines (therapy, medical visits, ancillary services)
• Prepare, review and submit inpatient claims.
• Ensure accurate claim creation based on CPT/HCPCS codes, modifiers, and visit documentation.
• Validate claims against payer-specific rules, authorization requirements, and medical necessity guidelines.
• Work claim edits and rejections prior to submission to reduce downstream denials. - 45%

Denials Management & Accounts Receivable Follow-Up

• Proactively manage assigned inpatient and outpatient claim denials, including coding issues, authorization denials, and medical necessity edits.
• Perform detailed accounts receivable follow-up with a focus on outpatient aging.
• Identify trends in denials and escalate or recommend process improvements.
• Submit corrected claims, appeals, and supporting documentation as needed. - 25%

Other Business Office Functions

• Manages medical billing operations including reviewing/submitting lab claims, preparing claim appeals and resubmissions, and maintaining Oklahoma State Discharge Reports.
• Handles patient account administration by ensuring accurate and timely patient statements, responding to account inquiries, and preparing supporting medical records
• Supports office by recording check payments, assisting with mail distribution, and reconciling payment entries with accounting department deposits. - 25%

Other duties as assigned. - 5%

Qualifications

Qualifications

Education: - High School Diploma or equivalent.

Experience: - 2+ years of outpatient medical billing experience in a clinic or multi-specialty environment. 2+ years of billing experience with Medicaid, Managed Medicaid, and Commercial payers is required.Experience with high-volume, visit-based billing (CPT/HCPCS coding workflows) is preferred.Experience with therapy billing (PT/OT/ST), physician services, or outpatient rehabilitation strongly preferred.Experience working denials, edits, and payer-specific billing rules is preferred.

License/Certification/Credential: - None

About Us

Our work begins where we are all equal - at the heart.

Bethany Children's Health Center is an innovative leader in the field of pediatric rehabilitation and 24-hour complex care. The hospital offers inpatient and outpatient services for children (ages 0-21) and is the only inpatient pediatric rehabilitation facility in Oklahoma. Our CARF accredited multidisciplinary team works with patients and their families to maximize the patient's physical and cognitive potential, and ensure the family has the training and resources needed for a smooth transition from hospital to home. In 2021, the hospital received accreditation from The Healthcare Facilities Accreditation Program (HFAP), the nation's original independent accreditation program recognized by the Centers for Medicare and Medicaid Services (CMS). This distinction confirms that Bethany Children's Health Center is providing high quality patient care as determined by an external process of evaluation.

In order to maximize the potential of every child, we must maximize the potential of every employee. We are committed to providing staff with the physical, emotional, spiritual, financial and mental resources necessary to achieve their potential and meet our standards of excellence. BCHC offers competitive compensation, benefits, state-of-the-art equipment and wellness programs. Opportunities for professional growth include in-service training, leadership development, tuition reimbursement and scholarships.

**Due to the nature of our pediatric services, this organization's positions are classified as safety-sensitive roles. Bethany Children's Health Center may refuse to hire an applicant or discharge an employee in a safety-sensitive position, who tests positive for marijuana even if the applicant or employee holds a valid Oklahoma medical marijuana license.