Under direction, to lead and supervise a section of medical billing business office, with staff performing varied and complex medical billing accounting work, or other units performing similar work through subordinate supervisors with business office accounting functions of moderate complexity; and to do related work as required.
Positions in this class must be fully qualified and competent in medical billing and coding. Positions in this class differ from the lower class of Medical Billing Technician in that positions in the latter class are responsible for the recovery of costs for medical care through billing of patients, insurers, third party payers, or various medical aid programs whereas positions in the higher level class supervise medical billing business office units with varied functions of moderate accounting complexity. Incumbents may also perform complex technical accounting assignments generally related to medical billing.
Performs full scope of medical billing revenue capture, including appeal processing;
Identifies billing workflow problems with the claims management system and clearinghouse to ensure resolution for medical billing revenue capture;
Develops workflows for claims transmission and reconciliation;
Serves as electronic health record billing liaison, solving complex technical billing problems in coordination with practice management system provider;
Provides instructions and makes decisions on difficult medical billing accounting problems in connection with the work of business office accounting and other clerical staff;
Plans, assigns, reviews and monitors work of subordinate staff for adherence to established procedure and accuracy, completion and conformance to applicable rules and regulations, and makes changes as appropriate;
Schedules work to meet deadlines;
Establishes priorities and determines efficient ways to organize tasks of subordinates;
Ensures compliance with medical billing policy, both internally and as directed by payer sources;
Coordinates work with other units and offices to ensure efficient work flow;
Makes recommendations on or selects subordinates, trains, directs and reviews work, prepares performance evaluations, issues warnings, prescribes work schedules and vacations;
Studies medical billing accounting procedures and systems, makes recommendations and directs the implementation of new/revised systems and procedures;
Explains complex medical billing and accounting processes and applications;
Uses computerized and/or manual systems to enter, retrieve and perform basic analysis of data;
Performs complex technical medical billing accounting assignments, including reconciliations;
Evaluates and processes insurance write-offs and bad debt associated with patient accounts;
Works on special projects as assigned;
May provide vacation or other temporary relief for other classes as required.
Medical billing accounting methods, practices, terminology, and insurance claim processing procedures;
Billing and patient accounting within practice management systems;
Revenue cycle billing transactions and reconciliation processes;
Business office organization, procedures and practices; and
Record keeping systems using mathematical and analytical skills.
Basic medical and current procedural terminology;
Pricing for health care services;
EPIC or similar electronic health record system; and
Governmental and private insurance programs.
Medical billing for federally qualified health centers;
Workflow development for billing and medical support staff; and
Coordination and testing for billing problem resolution within practice management systems;
Plan, assign, supervise and coordinate the work of employees performing complex medical billing accounting functions;
Devise and adapt work procedures and record keeping systems to meet changing needs;
Troubleshoot errors related to billing activities;
Understand, interpret and apply laws, rules and written and verbal directions;
Research and apply legal requirements associated with medical billing practices and related accounting transactions;
Use computerized systems to enter, retrieve and perform data analysis;
Establish and maintain effective working relationships with all levels of medical, professional, administrative and support personnel contacted in the course of work;
Write neatly and legibly;
Spell correctly and use correct business English, Spanish may also be required.
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 three years of full-time experience in the class of Medical Billing Technician or in an equivalent or higher clerical class performing medical billing or medical accounting in a County Health Services Agency or other similar environment;
The equivalent of four years full time experience performing medical billing or medical accounts receivable functions;
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.