Billing & Prior Authorization Specialist

Job Description:

Billing & Prior Authorization Specialist

Description

Job Posting Title
Billing & Prior Authorization Specialist

Agency
340 OKLAHOMA STATE DEPARTMENT OF HEALTH

Supervisory Organization
340 Allied Health

Job Posting End Date

Refer to the date listed at the top of this posting, if available. Continuous if date is blank.

Note: Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

Estimated Appointment End Date (Continuous if Blank)

Full/Part-Time
Full time

Job Type
Regular

Compensation
The salary for this position is up to $60,000.00 based on education and experience.

Why you’ll love it here!

RESPECT. COLLABORATION. SERVICE. The Oklahoma State Department of Health (OSDH) is committed to leading Oklahoma to prosperity through health. Our mission is to protect and promote health, prevent disease and injury, and cultivate conditions by which Oklahomans can thrive. Check out why we are passionate about public health and believe it is the career for you!!!

Oh yeah, did we mention perks? We know that benefits matter and that is why we offer a competitive benefits package for all eligible employees.

• Generous state paid benefit allowance to help cover insurance premiums.
• A wide choice of insurance plans with no pre-existing condition exclusions or limitations.
• Flexible spending accounts for health care expenses and/or dependent care.
• Retirement Savings Plan with a generous match.
• 15 days of vacation and 15 days of sick leave the first year for full time employees.
• 11 paid holidays a year.
• Student Loan repayment options & tuition reimbursement.
• Employee discounts with a variety of companies and venders.
• Longevity Bonus for years of service

Job Description

Location: Open to the best applicant statewide

Salary: up to $60,000.00, based on education and experience

Full Time /Part Time: Full Time

Work Schedule: Monday - Friday

Primary Hours: 8-5

Position Description:

The AHTP Medical Billing & Prior Authorization Specialist provides centralized coordination of reimbursement and payer compliance functions for the statewide Allied Health Service Programs and Pediatric Audiology Program. This position reports to the Allied Health Technical Manager and performs work with a high degree of independent responsibility within established agency policies and procedures.

The position supports the integrity, consistency, and compliance of outpatient reimbursement operations and contributes to revenue stability through oversight of billing and authorization processes. The work has statewide operational impact and requires collaboration with internal program staff and external payer partners.

This position does not supervise staff but provides Subject Matter Expert technical guidance within the Allied Health Service & Pediatric Audiology Programs.

Position Responsibilities/Essential Functions:

Revenue Cycle Management

• Review, correct, and resubmit denied or rejected claims according to payer requirements.
• Post and reconcile payment/non-payment information from remittance advice (RA/EOB) in billing systems.
• Monitor claims through adjudication and resolve billing discrepancies timely.
• Identify denial trends and implement corrective actions to improve claim outcomes.
• Verify insurance eligibility, benefits, authorizations, and coverage requirements, including hearing aids and assistive technology.
• Prior Authorization Administration
• Submit, track, and follow up on prior authorizations in compliance with payer requirements.
• Review authorization documentation for accuracy and completeness.
• Maintain authorization records in EHR and billing systems.
• Monitor authorization timelines, service limits, and payer requirements to ensure uninterrupted reimbursement.
• Coordinate with clinical staff on approvals, denials, documentation needs, coverage limitations, and out-of-pocket costs.
• Collaborate with backup billing staff on authorization processes.
• Credentialing & Payer Maintenance
• Support provider credentialing and enrollment for Medicaid, Medicare, managed care, and private insurance for AHS programs and Pediatric Audiology.
• Maintain accurate provider and payer information in billing systems.
• Assist with payer portal access and documentation updates.
• Systems Support & Process Improvement
• Identify and resolve system, workflow, and claim processing issues.
• Coordinate with payers, vendors, clearinghouses, providers, and staff to address insufficiencies
• Support referral, order intake, and documentation processes to ensure billing and authorization accuracy.
• Maintain compliance with payer policy, documentation, and form changes.
• Recommend and support process improvements to enhance efficiency, accuracy, and compliance.
• Training & Program Support
• Develop guidance materials and provide staff training/technical assistance.
• Serve as an authorization resource for program staff and external partners.
• Respond to inquiries professionally and timely.
• Maintain confidentiality and comply with regulatory requirements.
• Regular office presence required.
• Perform other duties as assigned.

• Other Duties
• Demonstrates knowledge of and supports mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
• Works effectively in team environment, participating and assisting their peers.

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Minimum Qualifications:

Four (4) or more years of experience in a medical or behavioral health office setting.

OR

A bachelor’s degree in a related field and one (1) year of relevant experience

OR

An equivalent combination of education and experience.

Substitution: Six semester hours completed at an accredited college or university may substitute for each six months of required experience. Completion of a vocational training course in medical billing may substitute for required experience

Preferred Qualifications:

Professional medical billing and/or coding experience in Speech-Language Pathology, Audiology, Behavioral Health, Occupational Therapy, Physical Therapy, or related disciplines.

Experience with Medicaid, Medicare, managed care organizations, and private insurance billing.

Experience providing training to individuals or groups.

Applicants must be willing and able to perform all job-related travel normally associated with this position and possess a valid driver’s license.

Application Requirements:

• 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.

Valued Knowledge, Skills and Abilities

Knowledge of insurance benefit verification and authorization requirements.

Knowledge of Medicare, Medicaid, managed care, and third-party billing procedures.

Familiarity with CPT/HCPCS coding applicable to allied health services.

Understanding of denial codes and resolution processes.

Knowledge of patient accounts receivable processes.

Ability to analyze billing issues and develop appropriate solutions.

Strong written and verbal communication skills.

Ability to manage multiple priorities with attention to detail.

Strong customer service orientation.

Physical Demands and Work Environment:

Work is typically performed in an office setting with climate-controlled settings and exposure to moderate noise levels. While performing the duties of the job, employees are required to talk, stand, walk, and reach with hands and arms. This position requires long periods of sitting and daily use of computers and phones. Employees must be willing to complete all job-related travel associated with this position. Being present in the office is an essential function of the job.

Equal Opportunity Employment

The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability.

Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub .

If you are needing any extra assistance or have any questions relating to a job you have applied for, please click the link below and find the agency for which you applied for additional information:

Agency Contact