Medical Billing Specialist I/II

Medical Billing Specialist I: $19.95 - $24.27

Under general direction, to perform specialized clerical work in connection with processing and billing fiscal intermediaries for medical services rendered to patients; and to do other work as required for Behavioral Health Services.  

DISTINGUISHING CHARACTERISTICS:

Medical Billing Specialist I

This is an entry-level classification in the Medical Billing Specialist series; incumbents will be expected to perform more routine duties while gaining additional experience and familiarity with departmental policies and procedures.  This position is responsible for working with medical billing documents, reviewing and verifying insurance accounts against third party billing program provision and procedures.  Incumbents in this class are expected to solve routine problems without assistance while unusual problems are referred to a supervisor.

Medical Billing Specialist II

This is the Journey-level classification in the Medical Billing Specialist series; Incumbents will be expected to perform more technical duties related to medical billing functions.   This position is responsible for working with medical billing documents, reviewing and verifying insurance accounts against third party billing program provision and procedures; interpreting policies, rules, or regulations on billing related matters and/or assisting in the coordination of procedures among various patient accounts systems.   Incumbents in this class are expected to solve routine as well as highly complex problems without assistance.

Medical Billing Specialist I

• Check and correct bills and accounts for numerical accuracy and proper coding, and prepare paperwork for data entry.
• Input service claims into Electronic Health Record billing system.
• Verify billing account or insurance forms for completeness and accuracy against a variety of automated and manual records.
• Review patient accounts to determine the accuracy of account information and make any required adjustments for proper billing purposes.
• Review monthly paid, denied and rejected claims for Medi-Cal and third party insurance companies.
• Process denied claims through Electronic Rebill System if applicable for reimbursement.
• Prepare self-pay bills; close charges for pay client accounts; review bills for accuracy.
• Post payments received from various funding sources.
• Process explanation of benefits when additional information from payer sources is requested.
• Assist department in training, implementing and complying with federal electronic health mandates.
• Update client data including admission/discharge, CSI reporting, diagnosis, and financial eligibility.
• Track and reconcile daily time studies for department staff and contract workers.
• Act as resource or subject matter expert for Electronic Health Record system.
• Submit data on Behavioral Health Information Systems (BHIS); prepare and transmit Medi-Cal Electronic Billing submittals to Department of Healthcare Services through the BHIS.
• Prepare HCFA billing to third-party insurances, including Medicare. 

Medical Billing Specialist II      In addition to above:

• Investigate and reconcile denials from private insurance.
• Investigate and reconcile denials from Medicare
• Process Medi-Cal denials.  
• Process Medi-Cal provider certifications.  
• Works independently with third party Electronics Health Record personnel.
• Independently Submits data on BHIS; prepare and transmit Medi-Cal Electronic Billing submittals to Department of Mental Health through the BHIS.
• Independently processes the medical disallowances and voids and replaces claims. 
• Interviews clients to set up financial payment plans. 
• Handles work of a complex nature related to medical billing. 
• Prepares and presents reports related to claims.
• Assumes responsibility for ensuring that internal controls are applied to medical billing activities per departmental policies.
• Provides training to staff regarding the Electronic Health Record and Specialty Mental Health and Substance Abuse Billing
• Identifies procedural needs and drafts policies 

Knowledge of:

Medical Billing Specialist I

Basic methods, practices, and terminology of fiscal clerical work including basic billing methods, procedures, and techniques; basic clerical auditing and verification techniques; medical terminology, and billing forms. 

Medical Billing Specialist II

Advanced methods, practices, and terminology of fiscal clerical work including advanced billing methods, procedures, and techniques; general clerical auditing and verification techniques; computerized accounting and medical billing systems, medical terminology, and billing forms. 

Ability to:

Medical Billing Specialist I

Understand and apply rules and regulations pertaining to medical billing policies and procedures while identifying routine billing errors and differentiate between appropriate applications of various billing methods; perform basic arithmetic computations rapidly and accurately and post the results on accounting records; organize work to meet prescribed deadlines; operate automated keyboard equipment; follow oral and written directions.

Medical Billing Specialist II

Understand and apply rules and regulations pertaining to medical billing policies and procedures while identifying complex billing errors and differentiate between appropriate applications of various billing methods; perform advanced arithmetic computations rapidly and accurately and post the results on accounting records; organize work to meet prescribed deadlines; operate automated keyboard equipment; follow oral and written directions; identify and respond to procedural and policy development requirements.  

TRAINING AND EXPERIENCE:

Medical Billing Specialist I

Equivalent to graduation from high school and two years’ experience performing financial, statistical, or fiscal record keeping functions with at least one year involving third party intermediary medical billing.

Medical Billing Specialist II

Equivalent to graduation from high school and three years’ experience performing financial, statistical, or fiscal record keeping functions with at least one year involving third party intermediary medical billing.

Possession of an appropriate California operator’s license issued by the State Department of

Motor Vehicles may be required.