MEDICAL BILLING TECHNICIAN

Job Specifications

Class Code: CH4 Analyst: JML, CB

Date Originated: 1/04 Date Revised: 3/18

SANTA CRUZ COUNTY

DEFINITION

Under direction, responsible for the recovery of costs for medical care through the billing of patients, insurers, third party payers, or various medical aid programs; and performs other work as required.

DISTINGUISHING CHARACTERISTICS

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 Senior Account Clerk in that the work requires greater knowledge of medical billing procedures and codes. Positions in this class differ from the higher class of Senior Medical Billing Technician in that positions in the latter class supervise medical billing units with varied functions of moderate accounting complexity and perform complex technical accounting assignments generally related to medical billing.

TYPICAL TASKS

· Assign diagnostic and procedure codes when required for facility and professional fee billing and statistical indices;

· Assign CPT and HCPS billing codes with appropriate modifiers when required for facility and professional fee billing and statistical indices;

· Assign codes to each diagnosis and procedure;

· Identify and code the providers who ordered or provided services in each health care encounter as required for facility and professional fee billing and statistical indices;

· Assemble patients health information by ensuring initial medical charts are complete;

· Comply with federal and state regulations regarding assigning any of the above codes for reimbursement;

· Abstract demographic, cancer discovery, treatment and follow-up data as required by state law utilizing the California Cancer Reporting Systems standards;

· Assign ICD-O site and histology codes for each case entered in the hospital cancer registry;

· Stage each case using the American Joint Committee on Cancer and the Surveillance Epidemiology and End Results Program coding methodologies;

· Use software programs to assign patients to ”diagnosis related groups” or DRGs;

· Use software programs to tabulate and analyze data to help improve patient care and other job related activities;

· Integrate lab, pharmacy, clinic and mental health billing to clear MediCare share-of-costs;

· Work with insurance companies on issues of prior approval, medical necessity, etc. to insure payment;

· Work with collectors on bad debt.

EMPLOYMENT STANDARDS

Thorough knowledge of:

• Medical billing procedures, operations and diagnostic and procedural coding
• Sources and eligibility requirements for publicly funded medical care payment programs such as Medicare, Medi-Cal, Short-Doyle Medi-Cal, Healthy Families and other private insurance
• Medical terminology and insurance claim procedures common to medical billing and accounts receivable operations
• Retroactive billing process for Medi-Cal and other payors where eligibility is established after service delivery.

Working knowledge of:

• Purposes, methods and practices of billing, accounts receivable, and collection.
• Basic medical terminology and spelling
• Current Procedural Terminology and other reference and resource materials related to patient account activities
• Managed care and fee-for-service payment methods
• Fiscal transactions, information, procedures and other related activities with intra- and inter-departmental units, other agencies
• A variety of fiscal records, ledgers, journals, computer data and other documents; maintenance of such records include the accurate posting, recording, balancing, adjusting and reconciling of figures, date or transactions
• Compilation, organization and preparation of a variety of complex reports dealing with fiscal transactions
• Collection and deposit of funds
• Modern office administrative practices and procedures, including business correspondence and computer skills
• Filing, office equipment operations and on-line computers
• Business arithmetic
• Principles and practices of customer service and telephone courtesy
• Purpose and use of International Classification of Disease Standards (ICD) and Diagnostic & Statistical Manual of Mental Disorders (DSM)
• Purpose and use of the Concurrent Procedure Terminology (CPT)
• Legal requirements of State, Federal and County Policies and Procedures related to billing and collection activity and the release of confidential patient information, including HIPAA requirements

Ability to:

• Prepare financial reports and maintain ledgers and journals using computer software
• Operate a patient accounts computer system
• Interpret program billing policies, procedures, and billing regulations
• Work independently with minimal direct supervision
• Plan and organize work
• Prepare accurate arithmetical computations
• Understand and follow oral and written directions
• Read and interpret procedure manuals
• Input accurate data into various computer systems in a timely manner
• Maintain patient confidentiality
• Operate 10-key adding machine
• Efficiently operate a keyboard
• Adjust to changes in workflow and meeting deadlines
• Communicate effectively orally and in writing
• Establish and maintain effective working relationships with all levels of medical, professional, administrative and support personnel contacted in the course of work
• In some assignments research, explicate, and prepare spread sheets on complex billing, accounts receivable, and insurance coverage records;
• Evaluate patient financial status and payer sources; establish payment plans, and follow-up and collect past due accounts
• Evaluate, determine and approve eligibility for specialized publicly funded medical care payment programs
• Perform detailed clerical work in a methodical and thorough manner with speed and accuracy
• Spell correctly and use correct business English
• Provide courteous customer service to patients
• Write neatly and legibly
• Supervise the work of subordinate clerical employees may be required of certain positions
• Physically and mentally be capable of performing the position’s essential functions as summarized in the typical tasks section of this specification

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 one year of full-time experience in the class of Senior Account Clerk or in an equivalent or higher clerical class performing medical billing or medical accounting in a County Health Services Agency or other similar environment;

Or

The equivalent of two years’ full time experience performing medical billing or medical accounts receivable functions

And

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

Bargaining Unit: 41
EEOC Job Category: 03
Occupational Grouping: 10
Workers' Compensation Code: 53