HD Program Specialist III

Summary

Billing Specialist The Billing Specialist position performs specialized administrative and financial work to support revenue cycle operations and the financial sustainability of clinical and public health services. This position manages billing for Medicare, Medicaid, private insurance, grant-funded services, and other reimbursement programs, including preventive health services, immunizations, screenings, and Community Health Worker services. Responsibilities include verifying eligibility, reviewing documentation, submitting claims, reconciling payments, managing accounts receivable, and maintaining accurate financial records. The Billing Specialist collaborates with clinical, program, and finance staff to improve billing workflows, reduce claim denials, strengthen audit readiness, increase reimbursement and collections, and convert eligible services into sustainable revenue that supports the organization's long-term financial stability. Works under general supervision, with moderate latitude for the use of initiative and independent judgment. This position is funded through September 23, 2027, employment beyond that date is not guaranteed.Essential Duties and Responsibilities Pursuant to the Americans with Disabilities Act (ADA), reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position. This job description outlines the primary duties of the role; however, additional related duties may be assigned.Data Analytics and AssessmentCollects, analyzes, and maintains billing, reimbursement, claims, accounts receivable (AR), and revenue cycle data to support operational and financial decision-making.Monitors billing performance indicators, including reimbursement capture, denial rates, AR aging, claim submission timelines, collections, and reimbursement trends.Maintains accurate billing records, documentation, reconciliation data, and supporting schedules for audit readiness and financial accountability.Utilizes billing, electronic health record (EHR), and financial systems to support claims processing, reporting, reconciliation, and revenue recovery.Analyzes reimbursement trends, claim patterns, and processing systems to identify revenue leakage, coding issues, workflow barriers, and opportunities for improvement.Prepares operational reports and performance metrics related to billing efficiency, reimbursement activity, accounts receivable, collections, and revenue cycle performance.Monitors ICD-10 and CPT coding trends, reporting patterns and conditions related to client services and communicates concerns or needed corrections to appropriate staff.Researches and reconciles discrepancies in claims, payments, accounts, bank statements, or appropriation balances and reports findings as appropriate.Policy Development/Program PlanningImplements billing processes, procedures, and workflows supporting Medicare, Medicaid, CHIP, private insurance, grant-funded services, and other reimbursement programs.Supports development and continuous improvement of billing workflows, documentation standards, standard superbills, and revenue cycle procedures.Participates in process improvement activities designed to reduce claim denials, improve reimbursement timelines, strengthen billing efficiency, and improve net collections.Assists in development and implementation of corrective actions addressing billing deficiencies, claim denials, coding issues, and reimbursement delays.Monitors payer requirements, reimbursement regulations, coding changes, eligibility criteria, and health plan agreements affecting billing operations.Contributes to financial and operational initiatives supporting revenue optimization, compliance, program sustainability, and continuous quality improvement.Assists in coordinating and communicating with WCCHD management, clinical and program staff, customer service staff, and others to ensure procedures interfacing with claims processing functions are documented and communicated effectively.Assists with maintenance, storage, and retention of billing and financial records in accordance with applicable record retention requirements.Communication and Cultural CompetencyCommunicates effectively in writing and orally with internal staff, providers, finance personnel, payers, patients, and external stakeholders regarding billing processes and reimbursement activities.Conveys billing requirements, documentation needs, eligibility information, coding requirements, and reimbursement procedures clearly and professionally.Prepares reports, correspondence, billing documentation, financial records, and supporting materials related to reimbursement activities.Communicates claim issues, denial trends, reconciliation findings, payment concerns, and billing risks to leadership and operational staff.Answers client, provider, payer, and staff inquiries regarding billing, claim processing, payment status, and reimbursement requirements.Maintains confidentiality and professionalism when communicating protected health information and sensitive financial information.Assists Division Directors, program staff, and auditors with billing and claims questions during fiscal and program audits.Health EquityApplies principles of equity, ethics, confidentiality, and nondiscrimination in billing and reimbursement activities.Supports equitable access to clinical services by facilitating billing processes across insured, underinsured, uninsured, and charity care populations.Recognizes barriers affecting healthcare access, reimbursement eligibility, service utilization, and patient understanding of payment processes.Ensures billing practices support culturally responsive and patient-centered service delivery.Maintains ethical standards and confidentiality requirements related to financial and patient information.Community PartnershipCollaborates with clinical programs, finance staff, providers, community health personnel, Williamson County, and external payer organizations to support reimbursement activities.Coordinates with internal departments to ensure accurate documentation, eligibility verification, coding, and timely claim submission.Supports implementation of reimbursement pathways for emerging services including preventive services, screenings, immunizations, and Community Health Worker services.Maintains effective working relationships with insurance representatives, Medicaid/Medicare contacts, health plans, and other reimbursement entities.Participates in cross-functional initiatives supporting financial sustainability and service delivery.Serves as a WCCHD liaison on billing issues and coordinates related electronic payment or credit card billing activities with Williamson County, as applicable.Public Health SciencesMaintains working knowledge of public health clinical services, preventive programs, immunizations, screenings, and reimbursement requirements affecting public health operations.Understands public health funding mechanisms and reimbursement pathways supporting clinical and preventive services.Applies regulatory guidance, payer requirements, ICD-10/CPT coding standards, and documentation requirements to billing activities.Supports sustainable funding strategies through improved reimbursement capture and revenue cycle performance.Maintains awareness of public health service changes affecting reimbursement opportunities and recognizes the relationship between public health services, access, and financial sustainability.Management and FinanceManages billing workflows supporting reimbursement capture, claims processing, accounts receivable management, and revenue cycle operations.Prepares and submits clean claims to Medicaid, Medicare, CHIP, private insurance, and other eligible payers electronically or by paper as required.Processes financial and billing claims for multiple programs accurately and in a timely manner and tracks claims through final disposition.Follows appropriate appeal and resubmission processes for denied or rejected claims within required timeframes.Maintains spreadsheets and supporting records for expenditures, billings, claims, reimbursements, and accounts receivable.Assists in preparing financial statements, vouchers, billing reports, and required financial or operational reports.Books claim revenue using WCCHD financial systems and maintains accurate fiscal documentation and reconciliation records.Works closely with program staff to resolve billing problems, improve documentation, and develop or maintain standardized superbills and billing tools.Monitors claim status, denial rates, AR aging, collections, reimbursement trends, and payment activity to improve financial outcomes.Maintains systems and controls necessary to provide accurate accounts of expenditures, revenues, and budget balances for agency programs.Processes and supports electronic payment systems, including credit card billing, and coordinates related activities with Williamson County as applicable.Applies critical thinking to identify billing inefficiencies, revenue leakage risks, and opportunities for process improvement.Leads all tasks related to enrollments/re-enrollments in Medicaid/Medicare/MCOs and private insurance.Supports measurable Revenue Cycle Management performance goals including billing capture, AR reduction, denial management, timely filing, and net collections improvement.Leadership and Systems ThinkingSupports organizational financial sustainability through revenue recovery and reimbursement optimization activities.Identifies system and process barriers affecting reimbursement capture, billing efficiency, financial performance, and staff workflows.Recommends workflow, system, and procedural improvements that strengthen revenue cycle management and reduce operational inefficiencies.Adapts

Job Description

Billing Specialist The Billing Specialist position performs specialized administrative and financial work to support revenue cycle operations and the financial sustainability of clinical and public health services. This position manages billing for Medicare, Medicaid, private insurance, grant-funded services, and other reimbursement programs, including preventive health services, immunizations, screenings, and Community Health Worker services. Responsibilities include verifying eligibility, reviewing documentation, submitting claims, reconciling payments, managing accounts receivable, and maintaining accurate financial records. The Billing Specialist collaborates with clinical, program, and finance staff to improve billing workflows, reduce claim denials, strengthen audit readiness, increase reimbursement and collections, and convert eligible services into sustainable revenue that supports the organization's long-term financial stability. Works under general supervision, with moderate latitude for the use of initiative and independent judgment. This position is funded through September 23, 2027, employment beyond that date is not guaranteed.Essential Duties and Responsibilities Pursuant to the Americans with Disabilities Act (ADA), reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position. This job description outlines the primary duties of the role; however, additional related duties may be assigned.Data Analytics and AssessmentCollects, analyzes, and maintains billing, reimbursement, claims, accounts receivable (AR), and revenue cycle data to support operational and financial decision-making.Monitors billing performance indicators, including reimbursement capture, denial rates, AR aging, claim submission timelines, collections, and reimbursement trends.Maintains accurate billing records, documentation, reconciliation data, and supporting schedules for audit readiness and financial accountability.Utilizes billing, electronic health record (EHR), and financial systems to support claims processing, reporting, reconciliation, and revenue recovery.Analyzes reimbursement trends, claim patterns, and processing systems to identify revenue leakage, coding issues, workflow barriers, and opportunities for improvement.Prepares operational reports and performance metrics related to billing efficiency, reimbursement activity, accounts receivable, collections, and revenue cycle performance.Monitors ICD-10 and CPT coding trends, reporting patterns and conditions related to client services and communicates concerns or needed corrections to appropriate staff.Researches and reconciles discrepancies in claims, payments, accounts, bank statements, or appropriation balances and reports findings as appropriate.Policy Development/Program PlanningImplements billing processes, procedures, and workflows supporting Medicare, Medicaid, CHIP, private insurance, grant-funded services, and other reimbursement programs.Supports development and continuous improvement of billing workflows, documentation standards, standard superbills, and revenue cycle procedures.Participates in process improvement activities designed to reduce claim denials, improve reimbursement timelines, strengthen billing efficiency, and improve net collections.Assists in development and implementation of corrective actions addressing billing deficiencies, claim denials, coding issues, and reimbursement delays.Monitors payer requirements, reimbursement regulations, coding changes, eligibility criteria, and health plan agreements affecting billing operations.Contributes to financial and operational initiatives supporting revenue optimization, compliance, program sustainability, and continuous quality improvement.Assists in coordinating and communicating with WCCHD management, clinical and program staff, customer service staff, and others to ensure procedures interfacing with claims processing functions are documented and communicated effectively.Assists with maintenance, storage, and retention of billing and financial records in accordance with applicable record retention requirements.Communication and Cultural CompetencyCommunicates effectively in writing and orally with internal staff, providers, finance personnel, payers, patients, and external stakeholders regarding billing processes and reimbursement activities.Conveys billing requirements, documentation needs, eligibility information, coding requirements, and reimbursement procedures clearly and professionally.Prepares reports, correspondence, billing documentation, financial records, and supporting materials related to reimbursement activities.Communicates claim issues, denial trends, reconciliation findings, payment concerns, and billing risks to leadership and operational staff.Answers client, provider, payer, and staff inquiries regarding billing, claim processing, payment status, and reimbursement requirements.Maintains confidentiality and professionalism when communicating protected health information and sensitive financial information.Assists Division Directors, program staff, and auditors with billing and claims questions during fiscal and program audits.Health EquityApplies principles of equity, ethics, confidentiality, and nondiscrimination in billing and reimbursement activities.Supports equitable access to clinical services by facilitating billing processes across insured, underinsured, uninsured, and charity care populations.Recognizes barriers affecting healthcare access, reimbursement eligibility, service utilization, and patient understanding of payment processes.Ensures billing practices support culturally responsive and patient-centered service delivery.Maintains ethical standards and confidentiality requirements related to financial and patient information.Community PartnershipCollaborates with clinical programs, finance staff, providers, community health personnel, Williamson County, and external payer organizations to support reimbursement activities.Coordinates with internal departments to ensure accurate documentation, eligibility verification, coding, and timely claim submission.Supports implementation of reimbursement pathways for emerging services including preventive services, screenings, immunizations, and Community Health Worker services.Maintains effective working relationships with insurance representatives, Medicaid/Medicare contacts, health plans, and other reimbursement entities.Participates in cross-functional initiatives supporting financial sustainability and service delivery.Serves as a WCCHD liaison on billing issues and coordinates related electronic payment or credit card billing activities with Williamson County, as applicable.Public Health SciencesMaintains working knowledge of public health clinical services, preventive programs, immunizations, screenings, and reimbursement requirements affecting public health operations.Understands public health funding mechanisms and reimbursement pathways supporting clinical and preventive services.Applies regulatory guidance, payer requirements, ICD-10/CPT coding standards, and documentation requirements to billing activities.Supports sustainable funding strategies through improved reimbursement capture and revenue cycle performance.Maintains awareness of public health service changes affecting reimbursement opportunities and recognizes the relationship between public health services, access, and financial sustainability.Management and FinanceManages billing workflows supporting reimbursement capture, claims processing, accounts receivable management, and revenue cycle operations.Prepares and submits clean claims to Medicaid, Medicare, CHIP, private insurance, and other eligible payers electronically or by paper as required.Processes financial and billing claims for multiple programs accurately and in a timely manner and tracks claims through final disposition.Follows appropriate appeal and resubmission processes for denied or rejected claims within required timeframes.Maintains spreadsheets and supporting records for expenditures, billings, claims, reimbursements, and accounts receivable.Assists in preparing financial statements, vouchers, billing reports, and required financial or operational reports.Books claim revenue using WCCHD financial systems and maintains accurate fiscal documentation and reconciliation records.Works closely with program staff to resolve billing problems, improve documentation, and develop or maintain standardized superbills and billing tools.Monitors claim status, denial rates, AR aging, collections, reimbursement trends, and payment activity to improve financial outcomes.Maintains systems and controls necessary to provide accurate accounts of expenditures, revenues, and budget balances for agency programs.Processes and supports electronic payment systems, including credit card billing, and coordinates related activities with Williamson County as applicable.Applies critical thinking to identify billing inefficiencies, revenue leakage risks, and opportunities for process improvement.Leads all tasks related to enrollments/re-enrollments in Medicaid/Medicare/MCOs and private insurance.Supports measurable Revenue Cycle Management performance goals including billing capture, AR reduction, denial management, timely filing, and net collections improvement.Leadership and Systems ThinkingSupports organizational financial sustainability through revenue recovery and reimbursement optimization activities.Identifies system and process barriers affecting reimbursement capture, billing efficiency, financial performance, and staff workflows.Recommends workflow, system, and procedural improvements that strengthen revenue cycle management and reduce operational inefficiencies.Adapts