Patient Billing Specialist (Accountant/Fiscal Analyst) - 61007383

Job Responsibilities

Careers at DPH: Work that makes a difference!

Pursuing Excellence, Inspiring Innovation, Promoting Teamwork, Embracing Service, and Advancing Equity

The South Carolina Department of Public Health (SC DPH) is seeking a detail-oriented and knowledgeable Patient Billing Specialist to support accurate, compliant, and efficient billing operations across the agency. This position plays a critical role in ensuring timely reimbursement, monitoring claim performance, and serving as a key resource for staff on billing policies, payer requirements, and revenue cycle best practices.

Job duties will include, but are not limited to:

• Policy Knowledge & Communication
  • Maintain up-to-date knowledge of program and payer policies, rules, and regulations related to billing and reimbursement.
  • Assist in developing and revising billing policies as needed.
  • Communicate policy updates through emails, trainings, and meetings to ensure consistent understanding across the organization.
    
• Claim Performance & Coordination
  • Monitor claim performance for assigned locations and payers using designated Revenue Cycle queues and Rev Manager tools.
  • Review claims, identify errors, and initiate corrective actions to improve payment accuracy and timeliness.
  • Investigate denials and rejections; coordinate corrections with appropriate staff.
  • Track and follow up on denials and rejects weekly, ensuring timely resolution and resubmission.
  • Maintain detailed documentation of follow-up activity on all claims.
    
• Secondary Claim Denials & Edit Failures
  • Monitor, review, and resolve items in the secondary Technical Denial and Edit Failure queue weekly.
  • Investigate and analyze denied insurance claims, identifying trends and recurring issues.
  • Research and follow up with Medicaid, Medicare, and private insurance companies via websites, phone communication, or written inquiries to resolve outstanding accounts receivable.
  • Initiate corrective actions as needed to improve payment outcomes.
  • Document all follow-up actions thoroughly.
    
• Audit & Record Requests
  • Participate in billing and financial audits to ensure compliance with established contracts, policies, and procedures.
  • Summarize audit findings, communicate results to responsible parties, and support the implementation of corrective actions.
  • Monitor regional record requests to ensure timely fulfillment.
  • Maintain audit and record-related files for review and retention.
    
• Other Duties as Assigned
  • Participating in presentations, workshops, and training sessions.
  • Assisting with revisions to the Patient Billing Manual.
  • Supporting updates and enhancements to billing systems and processes.

Minimum and Additional Requirements

State Minimum:
A high school diploma and professional experience in a related area such as accounting, auditing, finance, or banking. A bachelor's degree with multiple accounting courses may be substituted for the required work experience.

Institutions of Higher Learning must be recognized by the Council for Higher Education Accreditation.

Agency Minimum:
A bachelor's degree and one (1) year, associate's degree and three (3) years or a high school diploma and five (5) years of administrative or professional experience. Ability to work under conditions of constant change, perform acceptably under stress and be able to communicate orally and in writing at all levels of the agency. Position requires significant amount of intrastate travel.

**Any equivalent combination of education and/or experience that demonstrates the required knowledge, skills, and abilities may be considered in meeting the minimum qualifications, subject to approval by the DPH Chief Human Resources Officer, or their delegate.**

Applicants indicating college credit or degree(s) on the application may upload an unofficial copy of the transcript as an attachment to the application. Please note that the agency will require an official, certified copy of the transcript or diploma prior to hiring.

Preferred Qualifications

Medical billing and/or managed care experience. Thorough knowledge of billing Medicare, Medicaid and other third-party payers for health services. Ability to adjust to changing program needs for consultation/support/direction in relation to billing/revenue enhancement for program activities. Knowledge of computerized billing and MIS systems.

Additional Comments

EEO: The Department of Public Health is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth, or related medical conditions including, but not limited, to lactation), national origin, age (40 or older), disability, or genetic information.

REASONABLE ACCOMMODATION: Applicants needing accommodation for medical reasons or a sincerely held religious belief may submit a request for accommodation. A reasonable accommodation may be granted if it doesn't impose an undue hardship or pose a direct threat to the health and safety of others.

STATE DISASTER PLAN: In accordance with the State's Disaster Plan, which includes hazardous weather, Department of Public Health employees may be required to work in times of an emergency or disaster.

DRIVING RECORD: If this position requires the applicant to possess a valid driver's license to operate a state vehicle or personal vehicle, any applicant being considered in the final stages of selection for the position will be required to provide a certified copy of a 10-year driving record.

The South Carolina Department of Public Health offers an exceptional benefits package for FTE positions that includes:

• 15 days Annual (Vacation) Leave per year
• 15 days Sick Leave per year
• 13 Paid Holidays
• Paid Parental Leave
• Health, dental, vision, long-term disability, and life insurance for employees, spouse, and children. Click here for additional information.
• S.C. Deferred Compensation Program available (S.C. Deferred Compensation)
• Retirement benefit choices *
  • State Retirement Plan (SCRS)
  • State Optional Retirement Program (State ORP)

• Enrollment in one of the listed plans is required for all FTE employees; please refer to the contribution section of hyperlinked retirement sites for the current contribution rate of gross pay.

HYBRID WORK: The option to work partially remote or adjusted work hours may be available after 12 months of employment for approved positions.