Billing & Prior Authorization Specialist

State of Oklahoma • Oklahoma City, OK

7d • Onsite

About The Position

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.

Requirements

• 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.
• 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.
• Applicants must be willing and able to perform all job-related travel normally associated with this position and possess a valid driver’s license.
• All applicants are subject to a background check and must be legally authorized to work in the United States without visa sponsorship.

Nice To Haves

• 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.

Responsibilities

• 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.
• 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.
• 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.
• 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.
• 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.
• 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.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level