Billing Specialist - Private Insurance

CREOKS Health Services is establishing a mobile primary care clinic and expanding primary care services under the Oklahoma State Department of Health Rural Health Transformation Program (Rural Regional Reorientation). The Billing Specialist supports commercial and private insurance billing for these services, from eligibility verification through claim submission, payment posting, and denial resolution.

This position is funded through the RRR subaward. A central purpose of the role is to build CREOKS’ internal capacity: the contractor is expected to document the workflow and train CREOKS staff so the agency can carry the function independently at the conclusion of the grant period.

Duties & Responsibilities:

• Prepare, review, and submit claims to commercial and private insurance payers for services delivered by the mobile primary care clinic and the CREOKS primary care clinics.
• Verify patient insurance eligibility and benefits in advance of service, and communicate coverage, prior authorization requirements, and patient financial responsibility to clinic staff.
• Review clinical documentation and coding for completeness and accuracy prior to claim submission, and query providers when documentation does not support the service billed.
• Post payments and reconcile remittance advices and explanations of benefits.
• Work denials and rejections: identify the root cause, correct and resubmit, and file appeals within payer timely-filing limits.
• Track accounts receivable aging for private insurance claims and report on collection rates, denial trends, and days in accounts receivable.
• Maintain payer-specific billing requirements, fee schedules, and prior authorization rules for the commercial payers with which CREOKS contracts.
• Coordinate with the Credentialing Specialist to confirm that claims are submitted only under providers and service locations with active payer effective dates.
• Document the private insurance billing workflow in step-by-step form, including payer-specific detail, so that CREOKS staff can operate the process independently at the conclusion of the grant period.
• Train designated CREOKS business office staff on the documented workflow and verify competency before the contract ends.
• Maintain patient financial information in accordance with HIPAA, CARF, and CREOKS policy.
• Read and be knowledgeable of all current CREOKS policies and procedures.
• Responsible for understanding and following all administrative, clinical, and programmatic policies and procedures of the agency.
• All other duties as assigned.

Qualifications / Competencies Required:

• High school diploma or equivalent required; associate degree in health information management, accounting, business administration, or a related field preferred.
• Minimum of two (2) years of medical billing experience, including direct experience billing commercial and private insurance payers.
• Working knowledge of CPT, HCPCS, and ICD-10-CM coding and of CMS-1500 claim submission.
• Experience with electronic health record and practice management billing modules; clearinghouse experience preferred.
• Certification as a Certified Professional Biller (CPB), Certified Professional Coder (CPC), or Certified Medical Reimbursement Specialist (CMRS) preferred.
• Familiarity with FQHC, CCBHC, or community behavioral health billing preferred.
• Demonstrated ability to document a process clearly and transfer it to other staff.
• Working knowledge of HIPAA and patient financial confidentiality requirements.
• Strong attention to detail and the ability to work independently with limited supervision.

Travel and Other Special Conditions:

• This is primarily an administrative position. Occasional travel to CREOKS clinic locations may be required for staff training and workflow observation.
• Remote or hybrid work arrangements may be available subject to CREOKS policy.
• Travel reimbursed per CREOKS policy.

CREOKS Health Services is a non-profit organization providing comprehensive health, wellness, and social services. Our behavioral health division offers more than 40 years of quality services and program that benefit adult, adolescents, and children. We currently have 33 locations across Eastern & Southeastern Oklahoma. CREOKS’ reputation has allowed us to work with local agencies, schools, and civic organizations.

Whether you’re new to the field or a seasoned professional, joining CREOKS gives you the opportunity to affect meaningful change in people’s lives. It also means being a part of an accredited and recognized nonprofit who invests in your future. CREOKS offers a collaborative, positive work environment, free Continuing Education workshops, the NHSC Loan Repayment Program, competitive pay and a comprehensive benefits package.