Medical Billing/Coding Specialist

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%

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