Medical Billing Assistant I/II

DUTY SAMPLE

• Reviews and submits medical claims on behalf of the County for payment from Medi-Cal, Medicare, and other health care plans; reviews documents to verify completeness of claim, authorization for treatment and presence of required documentation, financial information, approvals and/or other needed data.
• Performs a detailed examination of all items billed to determine nature of procedure(s) included and eligibility for payment; reviews individual items on itemization reports to assess eligibility and amount shown for each item; disallows items as appropriate.
• Locates, interprets, and applies numerous complex and detailed medical codes, regulations, instructions and procedures to determine method to be used to calculate and/or re-determine amount allowed for each specific procedure/item.
• Reconciles individual items to specific categories; recognizes and extracts specific charges from grouping as billed for special handling and/or calculation at a different rate; and determines appropriate formula to be applied in each situation.
• Reviews medical chart notes, narratives and documents and extracts pertinent data such as medical information, Medi-Cal status, and authorizations for treatment to assist in determining appropriateness of charges and eligibility for payment.
• Uses the International Classification of Diseases to determine primary and secondary illness and treatment codes and records these codes and other statistical data on each claim processed.
• Responds to inquiries from medical providers and insurance companies; provides information on status of claims, proper claim procedures or general information; responds to inquiries concerning charges and payments; calls providers for clarification as needed.
• Performs mathematical calculations to determine amounts to be paid and verify accuracy of figures presented.
• Reviews records of patient/client visits to determine classifications of coverage to be billed such as private insurance, Medi-Cal/Medicare, governmental health insurance programs, laboratory services, and grant or other special funding sources; requests additional documents or documentation verbally or in writing to process claims, resubmits claim rejections or denials for reconsideration of payment, and follows-up on any unpaid claims.
• Prepares, verifies, and processes a wide variety of medical billing for services provided to patients/clients; performs accurate and timely data entry of codes and other information into electronic billing software programs.
• Performs reconciliation of remittances, post payments to patient/client accounts and research and resolve discrepancies.
• Provides information and assistance to other department support staff, supervisors and managers regarding medical coding and billing procedures in order to ensure accurate data is available for medical billing.
• Updates patient data and respond to inquiries from patients/clients, insurance companies, state or federal agencies, or health care facilities regarding status of patient accounts; combines and separates accounts to ensure proper pay classifications and correct statement billing; processes third-party pay forms, correspondence and bills; submits regular reports to supervisor concerning billing activities and statistics; perform special assignments such as compiling data on number and status of rejections or denials and other statistical data or reports; maintains accurate records of billing documents and documentation; may be assigned other clerical support or back-up duties as needed.
• Participates in regular meetings with supervisor, medical billing unit, and other department personnel.
• Provides training to less experienced staff and volunteers as assigned.
• Performs related duties as assigned.

MINIMUM QUALIFICATIONS **Minimum requirements must be met by the closing date**

• Medical Billing Assistant II: Two (2) years of experience at a level equivalent to the classification of Medical Billing Assistant I with Kings County.

SELECTION PROCESS: **EQUAL OPPORTUNITY EMPLOYER**