Medical Billing Technician (#CH4 )

$34.22-$43.32 hourly / $5,931.35-$7,508.66 monthly / $71,177.60-$90,105.60 yearly

• Assign diagnostic and procedure codes when required for facility and professional fee billing and statistical indices;
• Assign CPT and HCPS billing codes with appropriate modifiers when required for facility and professional fee billing and statistical indices;
• Assign codes to each diagnosis and procedure;
• Identify and code the providers who ordered or provided services in each health care encounter as required for facility and professional fee billing and statistical indices;
• Assemble patients health information by ensuring initial medical charts are complete;
• Comply with federal and state regulations regarding assigning any of the above codes for reimbursement;
• Abstract demographic, cancer discovery, treatment and follow-up data as required by state law utilizing the California Cancer Reporting Systems standards;
• Assign ICD-O site and histology codes for each case entered in the hospital cancer registry;
• Stage each case using the American Joint Committee on Cancer and the Surveillance Epidemiology and End Results Program coding methodologies;
• Use software programs to assign patients to ”diagnosis related groups” or DRGs;
• Use software programs to tabulate and analyze data to help improve patient care and other job related activities;
• Integrate lab, pharmacy, clinic and mental health billing to clear MediCare share-of-costs;
• Work with insurance companies on issues of prior approval, medical necessity, etc. to insure payment;
• Work with collectors on bad debt.

EMPLOYMENT STANDARDS

Thorough knowledge of:

• Medical billing procedures, operations and diagnostic and procedural coding;
• Sources and eligibility requirements for publicly funded medical care payment programs such as Medicare, Medi-Cal, Short-Doyle Medi-Cal, Healthy Families and other private insurance;
• Medical terminology and insurance claim procedures common to medical billing and accounts receivable operations;
• Retroactive billing process for Medi-Cal and other payors where eligibility is established after service delivery.

Working knowledge of:

• Purposes, methods and practices of billing, accounts receivable, and collection;
• Basic medical terminology and spelling;
• Current Procedural Terminology and other reference and resource materials related to patient account activities;
• Managed care and fee-for-service payment methods;
• Fiscal transactions, information, procedures and other related activities with intra- and inter-departmental units, other agencies;
• A variety of fiscal records, ledgers, journals, computer data and other documents; maintenance of such records include the accurate posting, recording, balancing, adjusting and reconciling of figures, date or transactions;
• Compilation, organization and preparation of a variety of complex reports dealing with fiscal transactions;
• Collection and deposit of funds;
• Modern office administrative practices and procedures, including business correspondence and computer skills;
• Filing, office equipment operations and on-line computers;
• Business arithmetic;
• Principles and practices of customer service and telephone courtesy;
• Purpose and use of International Classification of Disease Standards (ICD) and Diagnostic & Statistical Manual of Mental Disorders (DSM);
• Purpose and use of the Concurrent Procedure Terminology (CPT);
• Legal requirements of State, Federal and County Policies and Procedures related to billing and collection activity and the release of confidential patient information, including HIPAA requirements.

Ability to:

• Prepare financial reports and maintain ledgers and journals using computer software;
• Operate a patient accounts computer system;
• Interpret program billing policies, procedures, and billing regulations;
• Work independently with minimal direct supervision;
• Plan and organize work;
• Prepare accurate arithmetical computations;
• Understand and follow oral and written directions;
• Read and interpret procedure manuals;
• Input accurate data into various computer systems in a timely manner;
• Maintain patient confidentiality;
• Operate 10-key adding machine;
• Efficiently operate a keyboard;
• Adjust to changes in workflow and meeting deadlines;
• Communicate effectively orally and in writing;
• Establish and maintain effective working relationships with all levels of medical, professional, administrative and support personnel contacted in the course of work;
• In some assignments research, explicate, and prepare spread sheets on complex billing, accounts receivable, and insurance coverage records;
• Evaluate patient financial status and payer sources; establish payment plans, and follow-up and collect past due accounts;
• Evaluate, determine and approve eligibility for specialized publicly funded medical care payment programs;
• Perform detailed clerical work in a methodical and thorough manner with speed and accuracy;
• Spell correctly and use correct business English;
• Provide courteous customer service to patients;
• Write neatly and legibly;
• Supervise the work of subordinate clerical employees may be required of certain positions;
• Physically and mentally be capable of performing the position’s essential functions as summarized in the typical tasks section of this specification.

Training and Experience: Any combination of training and experience, which would provide the required knowledge and abilities, is qualifying. A typical way to obtain the knowledge and abilities would be:

The equivalent of one year of full-time experience in the class of Senior Account Clerk or in an equivalent or higher clerical class performing medical billing or medical accounting in a County Health Services Agency or other similar environment;

Or

The equivalent of two years’ full time experience performing medical billing or medical accounts receivable functions

And

Possession of one (1) of the following valid certifications (current): Certified Coding Specialist (all types) or Registered Health Information Administrator or Registered Health Information Technician or Certified Professional Coder (all types), or one year of similar experience in a medical setting outside of the County's medical services, or completion of an accredited medical billing and coding program at a college or institution of higher education

Special Requirements: Successful completion of a fingerprint background check.

EST: 1/04 REV: 3/18 Analyst: CB, JML