Medical Billing Specialist III/IV

Job Description:

Medical Billing Specialist III/IV

Description

Description

THE POSITION
Under general direction (III, IV), 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.

IDEAL CANDIDATE
The ideal candidate possesses comprehensive knowledge of medical reimbursement programs and the complexities of payment systems, including CPT, ICD-10, and HCPCS codes for Medicare and Medi-Cal payment processing. They are adept with the Medi-Cal Provider Manual and the TAR process, ensuring accurate and timely billing. Demonstrating excellent communication skills with peers, managers, patients, and payers, they efficiently handle billing processes to secure prompt reimbursements. The candidate excels in researching accounts for overcharges and appropriate billing information while identifying and resolving compliance and audit issues in collaboration with the compliance office. Additionally, they effectively lead and train billers on Managed Care, Medicaid, Medi-Cal, Medicare, and Commercial Insurance, ensuring regulatory adherence and operational efficiency.

DISTINGUISHING CLASSIFICATION LEVELS Positions are allocated to the various levels in this series on the basis of level, scope and complexity of professional billing duties assigned.

Medical Billin g Specialist III is the advanced-journey level class performing more complex work involving extensive analysis and research through the use of multiple electronic health record (EHR) systems such as Cerner, HURON, and/or Claim Source to follow up on accounts.

Medical Billin g Specialist IV is the lead level class and serves as technical advisors to lower-level Medical Billing Specialists. In addition to performing advanced-journey billing work, incumbents perform program administrative duties to assure that all claims are billed timely.
WHAT WE OFFER
The County of Ventura offers an attractive compensation and benefits package that includes:

• A general salary increase of 3.5% effective December 22, 2024.
• Merit Increases - New employees are eligible for an initial 5% merit increase within the pay range upon completion of at least 1,040 hours (approximately 6 months) assuming work meets satisfactory standards. Subsequent merit increases within the pay range will be upon completion of each additional 2,080 hours (approximately one year) from the initial merit increase.
• Educational Incentive - An educational incentive of 2.5% for completion of an associate's degree, 3.5% for completion of a bachelor's degree, OR 5% for completion of a graduate degree.
• Bilingual Incentive - Based on agency need, proficiency levels by exam are $.69 per hour (Level I), $1.00 per hour (Level II), or $1.32 per hour (Level III).
• Flexible Workweek/Telework Schedule - We support work life balance by offering compressed work (e.g., 9/80) and remote hybrid telework schedules for most positions subject to organizational needs and satisfactory performance.
• Vacation Accrual - New regular, full-time employees shall accrue approximately 14 days of vacation a year for the first 10,400 hours or 5 years of service; vacation accruals increase at 5, 11, 12, 13, 14, 15 and 20 years of service topping out at 26 days a year and 400 hours of vacation hours banked.
• Vacation Leave Redemption - After 14,560 hours of continuous County service an employee may elect to "cash in" or redeem up to 80 hours of vacation accrued in the same year after using 80 hours of vacation in the preceding 12 months.
• Sick Leave - Full time regular employees accrue 3.08 hours of sick leave per bi-weekly pay period with an advance at hire of 40.04 hours which will be balanced at the completion of 13 bi-weekly pay periods.
• Deferred Compensation - Eligible to participate in the County's 401(k) Shared Savings Plan and/or the Section 457 Plan. This position is eligible for up to a 3.00% match on your 401(k) contributions.
• Health Plans -Full time employees are given a flexible credit allowance of up to $21,450 annually to offset the purchase of medical, dental, and/or vision insurance for you and your dependents.
  • Employee only - $497 per biweekly pay period
  • Employee plus one dependent - $678 per biweekly pay period
  • Employee plus family - $825 per biweekly pay period
• Flexible Spending Accounts - Pre-tax benefit towards eligible medical, dental and vision care and/or dependent care expenses.
• Pension Plan - Participation in the County's defined pension plan, which has reciprocity with CalPERS.
• Holidays - 12 paid days per year which, includes a scheduled floating holiday.
• Additional Benefits - Tuition Reimbursement, Disability Plans, Employee Assistance Program, Life Insurance, Wellness Program.

APPROXIMATE SALARIES:
Medical Billing Specialist III - $ 25.10 - $31.86 per hour
Medical Billing Specialist IV - $ 27.86- $35.37 per hour

AGENCY/DEPARTMENT: Health Care Agency - Patient Financial Services

Medical Billing Specialist III/IV are represented by the Service Employees' International Union (SEIU) and are eligible for overtime compensation.

The eligible list established from this recruitment may be used to fill current and future Regular (including Temporary and Fixed-Term), Intermittent, and Extra-Help vacancies. There are currently three (3) Regular vacancies in Patient Financial Services.

NOTE: If appointed at the lower level, incumbent may be promoted to the higher level without further exam upon meeting the minimum requirements, demonstrating satisfactory performance, and in accordance with the business needs of the department.

TENTATIVE SCHEDULE
OPENING DATE: June 26, 2024
CLOSING DATE: Continuous

Examples Of Duties

Duties may include but are not limited to the following:

• Reviews and analyzes bills as they come off the system and bills/ transmits them in a timely manner to the appropriate intermediary;
• Ensures accuracy and compliance with billing, coding, and follow-up requirements and identifies overpayments and lack of documentation issues;
• Maintains work queue with backlog to 46 hours of receipt only;
• Reviews and follows up on denial codes transmitted to providers for potential reimbursement on claims;
• Provides information to payors and ensures that reimbursement is received.
• Gathers, compiles, and analyzes billing and statistical analysis;
• Prepares bills and claims and transmits them on a timely basis;
• Provides advanced-level billing and supervision as a lead person to the respective Medicare and or Medi-Cal Department;
• Reviews submittals to ensure accurate transmission and timely payment;
• Reviews bulletins to identify new programs that may affect reimbursement for Medi-Cal and/or Medicare and prepares reports;
• Serves as lead biller/specialist to the department; and
• Performs other related duties as required.

Medical Billing Specialist IV :
In addition to Medical Billing Specialist III level duties, Medical Billing Specialist IV may also include:

• Advises and consults with management on how to reduce the days in accounts receivable regarding Medicare, Medi-Cal, or insurance;
• Develops more effective training for staff in registration and billing and supervises or conducts training on the specific areas of Managed Care/Medicaid/Medi-Cal/Medicare and/or Commercial Insurance;
• Works with the billers and management to identify areas where reimbursement delays may be decreased; and
• Coordinates integration of workflow.

Typical Qualifications

These are entrance requirements to the examination process and assure neither continuance in the process nor placement on an eligible list.

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 Ventura County Medical Center and affiliated clinics.

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.

Medical Billing Specialist IV - Four (4) years of professional billing experience OR one (1) year as a Medical Billing Specialist III for the County of Ventura.

Desired:

• An Associate's or Bachelor's degree in a business-related field.
• Basic Proficiency using MS Excel
• Experience in Managed Care and Commercial Insurance billing.
• Experience with multiple electronic health record (EHR) systems, such as Cerner, HURON, and/or Claim Source to follow up on accounts.
• Supervisory experience.

KNOWLEDGE, SKILLS AND ABILITIES

Knowledge of:

• Medical reimbursement programs and complexity of payment systems.
• Current Procedural Terminology Codes (CPT) codes, International Classification for Diseases (ICD)-10 codes, Health Care Procedure Coding System (HCPCS) codes for payment processing of Medicare and/or Medi-Cal.
• Medi-Cal Provider Manual for Billing and Policy and Program and Eligibility.
• Treatment Authorization Request (TAR) process.

Ability to:

• Demonstrate open and direct communication with peers, managers, patients, and payers.
• Process bills accurately and receive prompt reimbursements.
• Research accounts for overcharges, appropriate billing information, and appropriate payment methodology.
• Evaluate and identify compliance and audit issues and work progressively with the compliance office to identify and resolve regulatory conflicts.
• Lead billers and conduct training on the specific areas of Managed Care/Medicaid/Medi-Cal/Medicare and/or Commercial Insurance .

Recruitment Process

FINAL FILING DATE: 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 at www.ventura.org/jobs. 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.

Note to Applicants: It is essential that you complete all sections of your application and supplemental questionnaire thoroughly and accurately to demonstrate your qualifications. A resume may be attached to supplement your responses in the above referenced sections; however, it may not be substituted in lieu of the application.

LATERAL TRANSFER OPTION : If presently permanently employed in another "merit" or "civil service" public agency/entity in the same or substantively similar position as is advertised, and if appointed to that position by successful performance in a "merit" or "civil service" style examination, then appointment by "Lateral Transfer" may be possible. If interested, please click here for additional information.

SUPPLEMENTAL QUESTIONNAIRE - qualifying: All applicants are required to complete and submit the questionnaire for this examination at the time of filing. The supplemental questionnaire may be used throughout the examination process to assist in determining each applicant's qualifications and acceptability for the position. Failure to complete and submit the questionnaire will result in the application being removed from consideration.

APPLICATION EVALUATION - qualifying: All applications will be reviewed to determine whether the stated requirements are met. Those individuals meeting the stated requirements will be invited to continue to the next step in the screening and selection process.

TRAINING & EXPERIENCE EVALUATION: A Training and Experience Evaluation (T&E) is a structured evaluation of the job application materials submitted by a candidate, including the written responses to the supplemental questionnaire. The T&E is NOT a determination of whether the candidate meets the stated requirements; rather, the T&E is one method for determining who are the better qualified among those who have shown that they meet the stated requirements. In a T&E, applications are either scored or rank ordered according to criteria that most closely meet the business needs of the department. Candidates are typically scored/ranked in relation to one another; consequently, when the pool of candidates is exceptionally strong, many qualified candidates may receive a score or rank which is moderate or even low resulting in them not being advanced in the process.

NOTE: The selection process will likely consist of an Oral Exam, which may be preceded or replaced with the score from a Training and Experience Evaluation (T&E), contingent upon the size and quality of the candidate pool. In a typical T&E, your training and experience are evaluated in relation to the background, experience and factors identified for successful job performance during a job analysis. For this reason, it is recommended that your application materials clearly show your relevant background and specialized knowledge, skills, and abilities. It is also highly recommended that the supplemental questions within the application are completed with care and diligence. Responses such as "See Resume" or "Refer to Resume" are not acceptable and may disqualify an applicant from further evaluation.


ORAL EXAMINATION - 100%: A job-related oral examination may be conducted to evaluate and compare participating candidates' knowledge, skills, and abilities in relation to those factors which job analysis has determined to be essential for successful performance of the job. Candidates must earn a score of seventy percent (70%) or higher to qualify for placement on the eligible list.

If there are three (3) or fewer qualified applicants, an oral examination will not be conducted. Instead, a score of seventy percent (70%) will be assigned to each application, and each applicant will be placed on the eligible list.

Candidates successfully completing the examination process may be placed on an eligible list for a period of one (1) year.

BACKGROUND INVESTIGATION: A thorough pre-employment, post offer background investigation which may include inquiry into past employment, education, criminal background information, and driving record may be required for this position.

For further information about this recruitment, please contact Nathan Wood by e-mail at nathan.wood@ventura.org or by telephone at (805) 677-5232.

EQUAL EMPLOYMENT OPPORTUNITY
The County of Ventura is an equal opportunity employer to all, regardless of age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding and related medical conditions), and sexual orientation.

Service Employees International Union (LOCAL 721)
(SEIU)

To learn more about Benefits, Retirement, and the Memorandum of Agreement (MOA), see links below.

• Benefits website or you may call (805) 654-2570.
• Retirement FAQ's
• Memorandum of Agreement

Union Code: UPP

Closing Date/Time: Continuous

Salary:

$52,216.65 - $73,565.49 Annually