Reimbursement, Billing and Data Specialist

Texoma Community Center•Sherman, TX

About The Position

The Reimbursement, Billing and Data Specialist performs specialized medical billing, claims processing, fee collection, and reimbursement maintenance for Texoma Community Center. The role supports accurate coding, timely claim submissions, accounts receivable follow-up, and compliance with Certified Community Behavioral Health Clinic (CCBHC) funding and Texas Health and Human Services guidelines. Other duties include determining eligibility, obtaining financial information, maintaining accounts, collecting charges for client services, preparing individual statements, and submitting encounter data. Work is performed in alignment with the center’s goals and trauma-informed, recovery-oriented models of care. The specialist handles electronic claims for Medicaid, Medicare, managed care organizations, and commercial payers; reviews electronic health record documentation before billing; posts payments and remittances; monitors and resolves receivables and claim denials; and conducts client financial assessments to establish sliding-scale fees. The role also assists clients with billing questions and payment arrangements, protects confidential information, and supports audits and reconciliation activities.

Requirements

High school diploma or GED equivalent.
At least one year of hands-on medical billing experience, including claims processing, electronic claim submission, coding, and denial resolution.
Proficiency with medical billing software, electronic health record systems, clearinghouses, and Microsoft Excel.
Current driver's license and a vehicle for use at work.
High attention to detail and accuracy in data entry and reconciliation.
Strong problem-solving skills related to insurance denials and payer guidelines.
Excellent verbal and written communication skills for client interactions and payer inquiries.
Ability to prioritize work, meet deadlines, and handle confidential information discreetly.
Self-motivated, organized, and detail-oriented.
Exceptional knowledge of the Office Suite.
Ability to perform basic arithmetic, handle money and make change, interpret and act on basic financial statements and regulations, communicate effectively, work cooperatively, and identify problems.
Knowledge of cultural differences and ability to work with people from different cultural backgrounds.
Consistently apply trauma-informed care principles and understand the pervasive nature of trauma.

Nice To Haves

Associate degree in healthcare administration, accounting, or a related field.
Experience working with individuals with mental illness and/or addiction issues.
Experience in behavioral health, community mental health center, or CCBHC billing environments.
In-depth knowledge of Texas Medicaid, managed care organization, and Medicare billing guidelines.
Certified Professional Coder (CPC) or Certified Revenue Cycle Representative (CRCR) certification.
Ability to speak a second language relevant to the population served.

Responsibilities

Prepare, scrub, and submit primary, secondary, and tertiary electronic claims for Medicaid, Medicare, managed care organizations, and commercial payers.
Review electronic health record documentation for accurate service and diagnosis coding and required authorizations before billing.
Post cash payments, electronic funds transfers, and Explanation of Benefits remittances to patient accounts.
Monitor accounts receivable aging and follow up on unpaid, delayed, or rejected claims.
Identify, appeal, and resolve claim denials, payment variances, and short-payments.
Conduct client financial intake assessments and establish sliding-scale fee agreements based on income guidelines and state requirements.
Respond to client billing inquiries, arrange payment plans, and help resolve account balances using a trauma-informed, customer-focused approach.
Maintain compliance with HIPAA, applicable state and federal regulations, and center policies for protected health information.
Assist with internal audits and reconcile daily posting logs against bank deposits and ledger entries.
Determine eligibility, obtain financial information, maintain accounts, collect client charges, create individual statements, and submit encounter data.
Practice the trauma-informed model of care and work effectively with individuals from different cultural backgrounds.