CLN Billing Specialist; OHG Administration

Overview

The OHG Billing Specialist is responsible for managing the full billing cycle across both insurance and company contract accounts for Occupational Health Group. This includes charge entry, claim submission, payment posting, denial management, reconciliation, and month-end reporting. In addition to workers’ compensation claims, the specialist handles occupational medicine company billing, including verification of authorizations, contracted services, monthly invoices, and physician/provider time allocations.

All team members are cross-trained in every function of the billing functions, ensuring department-wide coverage, efficiency, and accuracy. The position requires strong billing and coding knowledge, financial accuracy, and professional communication skills to maintain compliance with workers’ compensation regulations and company agreements.

Education Required

• High School Diploma or GED required.

Education Preferred

• Associates in Business, Accounting, or Health Administration preferred.

Experience

• 1-3 years of medical billing, accounts receivable, or revenue cycle experience (workers’ comp or occupational medicine preferred).
• Experience with claim submission, payment posting, denials/appeals, and reconciliations.
• Proficiency with billing systems, EHR platforms, and Microsoft Excel (reporting, lookups, pivots).
• Upholds effective work habits including, but not limited to, regular attendance, teamwork, initiative, dependability, and promptness.

Additional Skills/Abilities

• Excellent communication and customer service skills with insurance carriers, employers, and patients
• Strong organizational and reconciliation skills; detail-oriented with financial accuracy.
• Ability to perform all functions of the billing cycle; willingness to cross-train across tasks.
• Knowledge of medical billing, coding, workers’ compensation guidelines, and occupational medicine contract billing.
• Knowledge of Workers Compensation insurance agency operating procedures and practices.
• Knowledge of governmental, legal and regulatory provisions related to collection activities.
• Knowledge of the organizations policies and procedures.
• Ability to review and correct medical record documentation for billing accuracy (laterality, gender, age, provider notes).
• Ability to maintain confidentiality of sensitive information.

• Enter, review, and bill charges for workers’ compensation and occupational medicine services.
• Identify and correct billing, coding, and medical record errors to ensure accurate reimbursement.
• Identifies delinquent accounts, aging period and payment sources.
• Evaluates patient financial status.
• Review EOBs, resolve payment discrepancies, and process appeals/denials as needed.
• Submit claims with required documentation to insurance carriers by mail or electronically.
• Verify authorizations, procedures, and supporting records for occupational medicine services.
• Prepare and issue monthly invoices for contracted corporate clients (on-site nurses, medical assistants, CNPs, medical director time).
• Post and reconcile payments (insurance, employers, patients) and balance to cash posting logs and A/R worksheets.
• Prepare and reconcile month-end reports for Accounts Payable and ensure departmental balances are accurate.
• Performs aged accounts receivable actions including contacting responsible parties by statement, telephone and letter for all current accounts as well as old company accounts.
• Support departmental efficiency and coverage through cross-training in all billing cycle functions.
• Run and analyze financial/claims reports in Excel to support reconciliation and account monitoring.
• Participates in educational activities and attends required meetings.
• Other duties as assigned.