Official SealSan Joaquin County Human Resources Division


#0718-RO6115-01
Supplemental Questionnaire

Last Name
First Name
1

PATTERN I

Are you currently employed at San Joaquin General Hospital?  If yes, identify the following:

  • Position title
  • Duties performed
  • Average hours worked per week
  • Timeline of employment
1a

Do you possess at least one year of full-time paid experience at a level equal to or higher than a Senior Office Assistant in San Joaquin County service which included electronic billing and follow-up in a medical or health care setting?

Yes No
1b

If you responded yes, please provide the following information in the space below:

  • Job title
  • Employee ID (optional)
  • Number of hours worked per week
  • Department name
  • Brief description of your electronic billing and follow-up duties (include the types of insurance billed)
2

PATTERN II

Do you possess at least three (3) years of full-time paid experience performing medical billing for a hospital or high volume professional medical practice?

Yes No
2a

If you answered yes, do you possess at least two years of full-time paid experience functioning at a full journey level performing Medi-Cal and/or Medicare electronic billing?

Yes No

 

If you responded yes to the previous questions for Pattern II, please answer the following questions.  If you do not possess the experience, please indicate "N/A". 

Include in your responses the following information:

  • Job title
  • Dates of employment (from/to dates)
  • Number of hours worked per week
  • Name of hospital or professional medical practice employed
  • Specific duties performed directly related to the area specified

3

Describe your experience performing billing follow-up functions for reimbursement of patient charges.

4

Describe your experience performing electronic billing for insurance companies and other third party payers.

5

Describe your experience performing electronic billing for Medicare (third party billing payer).

6

Describe your experience performing electronic billing for MediCal (third party billing payer).