Medical Billing Specialist I/II/III - Behavioral Health
THE POSITION: Under general supervision (I), direction (II), and general direction (III), performs and is responsible for billing and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, Medicare, and general insurance reimbursement requirements.
Medical Billing Specialist I is the entry level in this series. Incumbents work under supervision of higher level Medical Billing Specialists and within established guidelines.
Medical Billing Specialist II is the journey level class performing a variety of billing and processing claims for reimbursement by programs.
Medical Billing Specialist III is the advanced-journey level class performing more complex work involving extensive analysis and research through the use of multiple systems, such as Avatar, Cerner, and/or Claim Source to follow up on accounts.
EXAMPLES OF DUTIES:
Duties may include but are not limited to the following:
Medical Billing Specialist I and II:
- Reviews and analyzes bills as they come off the system, examining for accuracy and completeness, requesting missing information as necessary, and bills/transmits them in a professional and timely manner to the appropriate intermediary;
- Ensures information in the patient’s EHR is accurate and up-to-date;
- Processes and reviews the Payor Financial Information (PFI) to ensure system is updated;
- Performs Share of Cost transaction;
- Provides and assists the clinic staff with billing corrections and edits;
- Assists patients and providers with billing questions, answering all telephone inquiries pertaining to assigned accounts; sets up patient payment plans and work collection accounts;
- Performs completion of claims to payers;
- Reviews accounts for insurance follow-up;
- Ensures accuracy and compliance with billing;
- Maintains work queue;
- Reviews and follows up on denied services transmitted to providers for potential reimbursement on claims;
- Provides information to payors and ensures that reimbursement is received;
- Prepares bills, monthly statements, and timely claims submission; and
- Performs other related duties as required.
Medical Billing Specialist III:
In addition to the Medical Billing Specialist I/II level duties, the Medical Billing Specialist III may also perform the following:
- Provides advanced-level billing and serves as a lead;
- Reviews submittals to ensure accurate transmission and timely payment;
- Reviews bulletins to identify new programs that may affect reimbursement and prepares reports;
- Deploys, maintains, and reports on various programs;
- Achieves maximum reimbursement for services provided;
- Resolves complex denials;
- Follows-up on missed payments and resolves financial discrepancies; and
- Performs other related duties as required.
EDUCATION, TRAINING, and EXPERIENCE
Any combination of education and experience which has led to the acquisition of the required knowledge, skills, and abilities. The required knowledge, skills, and abilities can typically be obtained by hands-on working knowledge and experience in a medical complex comparable to the Ventura County Medical Center and ambulatory clinics.
Medical Billing Specialist I - Minimum of six (6) months of medical billing experience required.
Medical Billing Specialist II - Two (2) years of professional medical billing experience including billing in Medi-Cal and chemotherapy OR one (1) year as a Medical Billing Specialist I for the County of Ventura.
Medical Billing Specialist III -Three (3) years of professional billing experience including preparation of financial statements OR two (2) years as a Medical Billing Specialist II for the County of Ventura.
FINAL FILING DATE: This is a continuous recruitment and may close at any time; therefore, apply as soon as possible if you are interested. Your application must be received by County of Ventura Human Resources in Ventura, California, no later than 5:00 p.m. on the closing date.
To apply online, please refer to our website by clicking the "Apply Externally" button. If you prefer to fill out a paper application form, please call (805) 654-5129 for application materials and submit them to County of Ventura Human Resources, 800 South Victoria Avenue, L-1970, Ventura, CA 93009.
For further information about this recruitment, please contact Erin Niemi by e-mail at email@example.com or by telephone at (805) 654-2568.