Medical Billing Specialist II - Patient Financial Services

Job Description:

Medical Billing Specialist II - Patient Financial Services

Description

Description

THE POSITION:
Under general direction, the incumbent is responsible for billing and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, Medicare, and general insurance reimbursement requirements.

The ideal candidate possesses strong problem-solving and analytical skills, customer service skills, and is committed to high productivity in a challenging work environment while providing service excellence while interacting with the public.

EDUCATIONAL/BILINGUAL INCENTIVE: Some positions may be eligible for educational incentive. This incentive may be 2.5%, 3.5%, or 5% for incumbents in eligible positions based on completion of an Associate's, Bachelor's, or Master's degree that is not required for the classification. Incumbents may also be eligible for bilingual incentives depending upon operational need and certification of skill.

AGENCY/DEPARTMENT: Health Care Agency

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 is currently one (1) Full-Time Regular position open in Health Care Agency - Patient Financial Services.
Medical Billing Specialist II is represented by the Service Employees' International Union (SEIU) and is eligible for overtime compensation.

TENTATIVE SCHEDULE
OPENING DATE: May 28, 2025
CLOSING DATE: Continuous and may close at any time; therefore, the schedule for the remainder of the process will depend upon when we receive a sufficient number of qualified applicants to meet business needs.

Examples Of Duties

Duties may include, but are not limited to, the following:

• Ensures accuracy and compliance with billing, coding, and follow-up requirements and identifies overpayments and lack of documentation issues and analyzes credits, payments, and over adjustments;
• Analyzes and updates claims generated prior to transmitting to the appropriate intermediary/payor within billing time frames;
• Addresses submitted claims in the work queue within two (2) business days of receipt;
• Reviews and follows up on denial codes transmitted to the billing department, analyzes reasons for denials, submits appeals and reconsideration requests, and makes appropriate corrections and retransmits claims;
• Provides requested information to payors and ensures that reimbursement is received, including medical records, missing provider information, and verifies and/or updates insurance coverage;
• Responds within two (2) business days to third-party payors, clinics, coworkers, supervisors, managers, physicians, and the public by email/phone/written communication;
• Gathers, compiles, and analyzes billing and statistical data and reviews encounters for payment accuracy based on services and contracts; and
• Performs other related duties as required.

Typical Qualifications

These are the entrance requirements to the examination process and ensure 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 two (2) years of professional medical billing experience, including billing in Medi-Cal and/or chemotherapy, in a medical complex comparable to Ventura County Medical Center and affiliated clinics.

OR

• One (1) year as a Medical Billing Specialist I for the County of Ventura.

NECESSARY SPECIAL REQUIREMENTS:

• Knowledge of Current Procedural Terminology (CPT) codes, International Classification for Diseases (ICD)-10 codes, and Health Care Procedure Coding Systems (HCPCS) codes.
• Knowledge of Treatment Authorization Request (TAR) process.
• Experience with billing in Medi-Cal.

DESIRED:

• Associate's or Bachelor's degree, or completion of a Vocational certificate in medical billing or a related field.
• Experience in Managed Care/Medicaid/Medicare and/or Commercial Insurance billing.
• Experience with multiple Electronic Health Record (EHR) systems, such as Cerner, HURON, and/or Claim Source to follow up on accounts.

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, Commercial Insurance and/or Medi-Cal.
• Medi-Cal/Medicare/Insurance Provider Manual for Billing and Policy and Program and Eligibility.
• Treatment Authorization Request (TAR) process.

Skill in:

• Customer service.
• Problem solving and analytical skills.

Ability to:

• Demonstrate open and direct communication with peers, managers, patients, and payers.
• Process bills accurately and receive prompt reimbursements.
• Review billing claims, analyze and correct errors, submit appeals and manage denials.
• Research accounts for correct payments, overcharges, accurate and complete billing information, and appropriate payment methodology in compliance with the Ventura County Health Care Agency (VC HCA) policies and procedures.
• Evaluate and identify compliance and audit issues and work progressively with the compliance office to identify and resolve regulatory conflicts.
• Communicate effectively, both orally and in writing.

Recruitment Process

FINAL FILING DATE: This is a continuous recruitment and may close at any time; therefore, apply as soon as possible if you are interested in it. Your application must be received by County of Ventura Human Resources 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 (Download PDF reader) 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 take the next step in the screening and selection process.

TRAINING and EXPERIENCE EVALUATION - qualifying: 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 that 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 be completed with care and diligence.

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

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.
For further information about this recruitment, please contact Yvonne Martinez by email at Yvonne.Martinez@ventura.org or by telephone at (805) 654-3051.

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

Salary:

$49,302.23 - $62,546.54 Annually