DHS Billing Specialist

Full-Time/ Non- Exempt Position
Starting Wage- $20.95-$23.28 

Job Summary
The DHS Billing Specialist performs specialized billing, accounts receivable, client account, and collection functions for Human Services programs. The position is responsible for accurate self-pay and third-party billing, client statements, payment application, insurance eligibility and benefit verification, secondary and tertiary claims, claim follow-up, payment plans, and delinquent account processes. The Specialist maintains accurate financial and payer information in the department’s electronic health record (EHR), including myEvolv, and works closely with the DHS Medical Billing Coordinator, program staff, clients, responsible parties, insurance carriers, and other payers to support timely and accurate reimbursement. The position requires strong attention to detail, independent problem-solving, confidentiality, and consistent application of County, payer, and program requirements.

Essential Functions and Responsibilities
The following duties are primarily performed and are essential for this position. Employees are expected to be able to perform each of these job duties satisfactorily and successfully with or without reasonable accommodation to be qualified for the position. Other duties may be required and assigned
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50% Self-Pay Billing, Client Accounts, Statements and Collections:
• Processes monthly Birth to Three (BT3) cost-share and Children’s Long-Term Support (CLTS) parental fee billing in the EHR; maintains accurate fee records and resolves discrepancies with appropriate program staff.
• Monitors EHR alerts, staff notifications, and contracted-provider documentation related to BT3 and CLTS fees; enters authorizations and supporting documentation into the client record as required.
• Generates and reviews monthly client statements for BT3, CLTS, Integrated Behavioral Health Services (IBHS), Partial Hospitalization Program (PHP), and other County-funded treatment services, including room and board, residential treatment, and inpatient hospital services, as applicable.
• Reviews client accounts for unapplied payments, incorrect balances, missing financial information, or other discrepancies and makes or coordinates corrections before statements are issued.
• Maintains accurate client financial, demographic, responsible-party, and self-pay information in the EHR.
• Explains client financial responsibility, account balances, payment options, and County billing processes to clients and responsible parties.
• Establishes, documents, and monitors approved payment plans and follows up on delinquent balances.
• Prepares and processes delinquent accounts for referral to the State Debt Collection Program or other approved collection process in accordance with County ordinance and departmental procedures; maintains supporting documentation and account status in the EHR.
35% Accounts Receivable and Third-Party Billing
• Generates and submits secondary and tertiary claims through payer-required methods, including electronic clearinghouse submission, payer portals, and paper claims.
• Reviews EHR enrollment and billing reports to identify newly enrolled clients and billing-related changes requiring action.
• Verifies insurance and Medicaid eligibility and benefits for clients receiving billable Human Services services, including IBHS, PHP, CLTS, Crisis, CSP, and CCS services, as applicable.
• Maintains accurate payer and benefit assignment information in myEvolv, including primary, secondary, tertiary, and self-pay responsibility.
• Enters and applies client and insurance payments in the EHR and reviews payment posting for accuracy.
• Identifies deductibles, copayments, coinsurance, coordination-of-benefit issues, and balances requiring transfer to another payer or client responsibility.
• Investigates denied, rejected, unpaid, or otherwise problematic claims; researches payer requirements and makes or coordinates corrections.
• Reviews unapplied payments, credit balances, potential refunds, and outstanding claims and coordinates appropriate follow-up.
• Reviews retroactive Medicaid eligibility when applicable and updates benefit assignments to support appropriate billing.
• Maintains clear documentation of billing actions, payer contacts, corrections, and follow-up activity.

15% Billing Operations and Department Support
• Works closely with the DHS Medical Billing Coordinator regarding payer updates, billing requirements, claim issues, workflow changes, and research needs.
• Assists with payer enrollment, provider credentialing and recredentialing, revalidation, and maintenance of agency and individual provider information as assigned.
• Obtains insurance authorizations when providing coverage for the DHS Medical Billing Coordinator or as otherwise assigned.
• Assists with reconciliation and maintenance of insurance and client payment records and other billing documentation.
• Assists with testing and validation of EHR billing workflows, reports, payer configuration, and system changes affecting accounts receivable or client billing.
• Identifies recurring billing errors, workflow concerns, or revenue-cycle issues and communicates them to the DHS Medical Billing Coordinator and Office Services Manager; assists with process improvement and procedure updates.
• Maintains current knowledge of payer requirements, County procedures, and applicable billing requirements and participates in relevant training, including Wisconsin regional billing specialist meetings.
• Provides backup billing support and performs other fiscal or administrative duties as assigned.

Supervision Exercised  
None. This position may provide functional guidance to reception and support staff regarding insurance, demographic, financial documentation, and client account requirements, but does not have formal supervisory authority.

Minimum Education Qualifications

Education and/or Experience Requirements
• Associate degree in medical billing and coding, accounting, health information, business, or a closely related field; or a medical billing/coding certification combined with relevant experience.
• Three (3) to five (5) years of healthcare, behavioral health, or human services billing experience, including accounts receivable, insurance claims, payment posting, or collections.
• Experience with Medicaid, Medicare, commercial insurance, behavioral health, substance use disorder, or county human services billing is preferred.
• Experience working with an electronic health record and electronic claims clearinghouse is preferred.

In evaluating candidates for this position, Ozaukee County may consider an equivalent combination of education, training, and experience that provides the knowledge, skills, and abilities necessary to perform the duties of the position.

Licenses, Certifications and Other Requirements
Medical billing, coding, or revenue-cycle certification is desirable but not required.

Knowledge
• Healthcare billing and accounts receivable practices, including claims submission, payment posting, denial follow-up, client responsibility, collections, and coordination of benefits.
• Medicaid, Medicare, commercial insurance, and self-pay billing concepts and payer requirements.
• Confidentiality, HIPAA, and fiscal recordkeeping requirements applicable to Human Services programs.
• Electronic health record billing functions, clearinghouses, payer portals, and related billing technology.
• Basic accounting and reconciliation principles related to client accounts and accounts receivable.
Skills
• Strong analytical, research, reconciliation, and problem-solving skills to identify and resolve billing and account discrepancies.
• High degree of accuracy and attention to detail when entering, reviewing, and reconciling financial and payer information.
• Effective verbal and written communication with clients, responsible parties, insurance carriers, providers, and County staff.
• Strong organization and time management, including prioritizing competing deadlines and maintaining timely follow-up.
• Proficiency with EHR systems, billing applications, payer portals, electronic clearinghouses, Microsoft Excel, and Microsoft Word.
• Professional customer-service and conflict-resolution skills when discussing financial responsibility, delinquent accounts, or disputed balances.
Abilities
• Interpret and apply payer rules, County policies, program requirements, and established billing procedures.
• Independently investigate claim issues, determine appropriate next steps, and escalate complex or high-risk issues when needed.
• Maintain confidentiality and exercise sound judgment when handling protected health information and financial information.
• Recognize patterns or recurring errors and recommend workflow or process improvements.
• Establish and maintain effective working relationships across Human Services divisions and with external payers and partners.
• Adapt to changes in payer requirements, technology, EHR workflows, and departmental priorities.
• Work independently while collaborating effectively as part of the department’s fiscal and administrative support team.

Physical Requirements
• Prolonged periods of sitting and working at a computer or other office equipment.
• Frequent keyboarding, data entry, document handling, and other repetitive office tasks.
• Periodic standing, walking, bending, reaching, and movement within the office.
• Ability to communicate effectively in person, by telephone, and electronically.
• Ability to occasionally lift, carry, or move office materials and files weighing up to approximately 20 pounds.
• Ability to perform the essential functions of the position with or without reasonable accommodation.
Work Environment

• Work is primarily performed in a professional office environment with regular use of computers, telephones, scanners, and other standard office equipment.
• Work may occur in a shared workspace and requires maintaining confidentiality when handling client, health, insurance, and financial information.
• The position involves frequent interaction with County staff, clients, responsible parties, insurance carriers, and other external contacts and may periodically involve difficult or sensitive financial conversations.
• Work requires managing multiple priorities, deadlines, and detailed financial information where accuracy and timely follow-up are essential.

EOE / ADA Statement
Ozaukee County is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, Ozaukee County will provide reasonable accommodations to qualified individuals with disabilities and encourages both prospective and current employees to discuss potential accommodations with the employer.
Nothing in this job description limits management’s right to assign or reassign duties and responsibilities at any time. The duties listed above are intended as illustrations of the types of work that may be performed. The omission of specific duties does not exclude work that is similar, related, or a logical assignment to the position. This job description does not constitute an employment agreement and is subject to change as organizational needs and job requirements change.

 

Ozaukee County offers a generous benefits package including: health, dental, life, & vision insurance; free employee health clinic & Teladoc; paid holidays, vacation, & sick time; state of Wisconsin WRS defined benefit pension program; bonus opportunities; employee fitness room; wellness program & wellness reimbursement; tuition reimbursement & continuing education opportunities; and more! Please note some that benefits offered are dependent on full-time/part-time status.

Ozaukee County prohibits discrimination and harassment of any type against applicants and employees on the basis of race, color, religion, sex, national origin, age, handicap, disability, genetics, veteran status or military service, marital status or sexual orientation, gender identity or expression, or any other characteristic or status protected by federal, state or local laws. Ozaukee County also provides reasonable accommodations to qualified individuals with disabilities in accordance with the requirements of the Americans With Disabilities Act and applicable state and local laws.