Healthcare Reimbursement & Billing Specialist
Healthcare Reimbursement & Billing Specialist
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$ 35984 - 62971
1 Vacancy
Job Description
Description of Work
This Position Is Funded In Part Through Federal Funds
The Healthcare Reimbursement Billing Specialist position supports billing and collection activities for patient accounts across thirteen State Operated Healthcare Facilities. The role is situated within the Central Billing Office of the DHHS Office of the Controller and requires managing complex accounts across a specialized healthcare patient billing platform. Responsibilities include verifying payer eligibility tracking patient records auditing claims and applying appropriate payment adjustments.
This position plays a critical role in the successful revenue cycle operations of the Central Billing Office by ensuring compliance with federal state and third-party billing requirements. The role supports data integrity for financial reporting and reimbursement while helping maintain operational continuity across institutional partners.
Key Duties Include:Manage inpatient and outpatient patient accounts from admission through discharge
Analyze and process charges payments and adjustments in specialized billing systems
Submit claims using electronic EDI X12 837I and 837P transactions; support paper UB04 and CMS1500 submissions
Follow up on denials and outstanding balances with Medicare Medicaid and commercial insurers
Verify claim compliance and insurance priority using payer portals and internal systems
Monitor and adjust financial class splits and ATP/PML data to ensure billing accuracy
Audit remittance data using EDI X12 835 formats; resolve discrepancies and initiate refunds or adjustments
Prepare and maintain Medicare Insurance Tracker and Commercial Insurance Payment logs for reporting
Reconcile system reports with billing data and submit monthly financial summaries by deadline
Coordinate with internal departments and external payers to resolve account and billing issues
About the NC Department of Health and Human Services (DHHS):The North Carolina Department of Health and Human Services (DHHS) is one of the largest most complex agencies in the state and has approximately 17000 employees. It is responsible for ensuring the health safety and well-being of all North Carolinians providing human service needs for special populations including individuals who are deaf blind developmentally disabled and mentally ill and helping poor North Carolinians achieve economic independence.
About DHHS Office of the Controller:The Office of the Controller sets and interprets all accounting and financial reporting policies and procedures for the Department as authorized by the rules and regulations of the Office of the State Controller and state statutes and executes all accounting transactions for DHHS.
Compensation and Benefits:The State of North Carolina offers excellent comprehensive benefits. Employees can participate in health insurance options standard and supplemental retirement plans and the NCFlex program (numerous high-quality low-cost benefits on a pre-tax basis). Employees also receive paid vacation sick and community service addition paid parental leave is available to eligible employees. Visit website for benefits: more information about DHHS: Skills and Abilities / Competencies
Candidates now meet the minimum qualifications of a position if they have the minimum education and experience listed on the vacancy announcement.
The Knowledge Skills and Abilities (KSAs)/ Management Preferences are not required. Applicants that possess the following skills are preferred:
Documented experience managing healthcare patient accounts using electronic billing platforms like Affinity or similar systems
Demonstrated experience with billing and remittance processing using EDI X12 5010 formats like 837I/P and 835I/P or similar healthcare billing reports
Proven experience submitting and resolving claims with insurers such as Medicare Medicaid Managed Care NCTracks or commercial insurers
Documented experience ofaccounting and auditing practices involving A/R and A/P preferably in a large multi-facility or healthcare environment
Minimum Education and Experience Requirements
Some state job postings say you can qualify by an equivalent combination of education and experience. If that language appears below then you may qualify through EITHER years of education OR years of directly related experience OR a combination of both. See details.
Qualified applicants must possess and application must clearly reflect work experience that demonstrates the following:
Associates degree in Accounting from an appropriately accredited institution and two years of experience in accounting
OR
High school diploma or General Educational Development (GED) diploma and four years of experience in accounting work
OR
An equivalent combination of education and experienceSupplemental and Contact Information
The North Carolina Department of Health and Human Services (DHHS) is an Equal Opportunity Employer who embraces an Employment First philosophy which consists of complying with all federal laws state laws and Executive Orders. We are committed to reviewing requests for reasonable accommodation at any time during the hiring process or while on the job. For more information about DHHS: uses the Merit-Based Recruitment and Selection Plan to fill positions subject to the State Human Resources Act with the most qualified individuals. Hiring salary will be based on relevant qualifications internal equity and budgetary considerations pertinent to the advertised position.
In accordance with the Governors Executive Order 303 our agency supports second-chance employment for individuals who were previously incarcerated or justice involved. We invite all potential applicants to apply for positions for which they may be qualified.
Application Process
Be sure to complete the application in its entirety. Resumes will not be accepted in lieu of completing this application.- Information should be provided in the appropriate areas to include the following: Education including high school and all degrees obtained Work Experience and Certificates & Licenses. It is critical to our screening and salary determination process that applications contain comprehensive candidate information.
- Answers to Supplemental Questions are not a substitute for providing all relevant information within the body of your application. To receive credit for the supplemental questions you must provide supporting information within the Work Experience section of the application to support your answers.
- If multiple applications are submitted to an individual posting only the most recent application received prior to the closing date will be must be submitted by 5:00 PM on the closing date.
- Applicants may be subject to a criminal background check. All candidates selected for positions considered Positions of Trust will be subject to a criminal background check.
- Due to the volume of applications received we are unable to provide information regarding the status of your application over the phone. To check the status of your application please log in to your account. Upon the closing date applications are Under Review and will be screened by Human Resources for the qualified applicants. The hiring process may take several weeks.
- Degrees must be received from appropriately accredited institutions. Transcripts and degree evaluations may be uploaded with your application. The State of North Carolina/Office of State Human Resources uses the National Association of Credential Evaluation Services (NACES) as a referral resource for applicants who need to have their credentials certified as equivalent.
- For a list of organizations that perform this specialized service please visit the NACES membership website at
Degree/College Credit Verification
Degrees must be received from appropriately accredited institutions. Transcripts degree evaluations and cover letters may be uploaded with your application.
Veterans and National Guard Preference
- Applicants seeking Veterans Preference must attach aDD-214 Member-4 Form(Certificate of Release or Discharge from Active Duty) to their applications.
- Applicants seeking National Guard Preference must attach an NGB 23A (RPAS) along with the state application if they are a current member of the NC National Guard in good standing.
- Applicants who are former member of either the NC Army National Guard or the NC Air National Guard with honorable discharge and six years of creditable service must attach a copy of the DD 256 or NGB 22 along with the state application.
ADA Accommodations
Consistent with the Americans with Disabilities Act (ADA) and the Pregnant Workers Fairness Act (PWFA) DHHS is committed to the full inclusion of all qualified individuals. As part of this commitment DHHS will ensure that people with disabilities or known limitations covered by the PWFA are provided with reasonable accommodation. If reasonable accommodation is needed to participate in the job application or interview process please contact the person indicated below.
NEOGOV Technical Assistance
For technical issues with your application please call the NeoGov Help Line at . If you have a technical issue with your Government Jobs account please call their Help Line at 1-.
CONTACT INFORMATION:
If there are any questions about this posting please contact Talent Acquisition at .Resumes will not be accepted in lieu of completing this application.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
