HD Program Specialist III

Division:Administration and Finance (AF)

Working Title: Billing Specialist

Direct Supervisor: Administration and Finance Director

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.

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.

• Collects, 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.

• Implements 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.

• Communicates effectively in writing and orally with internal staff, providers, finance personnel, payers, patients, and external stakeholders regarding billing processes and reimbursement activities.
• Conveys billing…