1635-Health Care Billing Clerk I

Job description

CITY & COUNTY OF SAN FRANCISCO

DEPARTMENT OF HUMAN RESOURCES

CLASS TITLE: HEALTH CARE BILLING CLERK I

JOB CODE: 1635

DEFINITION

Under supervision, reviews and evaluates medical claims to third-party payors, Medicare, and Medi-Cal for services provided to patients by the Department of Public Health. This classification is the entry-level class in the series.

DISTINGUISHING FEATURES

The 1635 Health Care Billing Clerk I is responsible for reviewing and evaluating all types of claims, including updating insurance information, and processes routine claims whereas the 1636 Health Care Billing Clerk II is responsible for processing all types of claims.

SUPERVISION EXERCISED

None.

EXAMPLES OF IMPORTANT AND ESSENTIAL DUTIES

According to Civil Service Commission Rule 109, the duties specified below are representative of the range of duties assigned to this job code/class and are not intended to be an inclusive list.

1. Reviews, evaluates, and processes bills for services rendered to patients in order to obtain reimbursement from various insurance carriers and government programs.

2. Evaluates billing documents and claims data for accuracy and completeness, obtaining missing or correct data when necessary from sources such as the patient's medical record, discharge summary, and Admissions forms.

3. Prepares the claims forms by completing the information required and categorizing the billing charges by grouping them according to types of medical services provided.

4. Reviews electronic and lockbox payments and posts to corresponding accounts.

5. Researches questions and concerns, and provides assistance to patients, physicians, insurance and legal representatives, and others regarding claims reimbursement and coverage.

6. Queries electronic databases in order to verify patient's medical records number to ensure that the proper medical chart is requested.

KNOWLEDGE, SKILLS, AND ABILITIES

Knowledge of: Medical claims processing for reimbursement; basic medical terminology; modern office practices and procedures; payment posting procedures.

Ability or Skill to: Perform detailed clerical work in a methodical and thorough manner and with speed and accuracy; read and analyze a medical chart; deal courteously and effectively with a variety of people; perform basic math; operate a personal computer using word processing, spreadsheet and database software.

MINIMUM QUALIFICATIONS

These minimum qualifications establish the education, training, experience, special skills and/or license(s) which are required for employment in the classification. Please note, additional qualifications (i.e., special conditions) may apply to a particular position and will be stated on the exam/job announcement.

Education:

Experience:

Six (6) months of experience billing, claims processing and/or collecting healthcare service reimbursements or medical claims from Medi-Cal (Medicaid), Medicare, insurance, third-party payors, and individual payors in a hospital, healthcare agency, or healthcare billing organization.

License and Certification:

Substitution:

Completion of 15 semester units or 22 quarter units of medical billing related coursework from an accredited college or university may substitute for six (6) months of qualifying experience.

SUPPLEMENTAL INFORMATION

PROMOTIVE LINES

To: 1636 Health Care Billing Clerk II

ORIGINATION DATE:

10/02/1979

AMENDED DATE:

03/13/18; 09/11/19

REASON FOR AMENDMENT:

To accurately reflect the current tasks, knowledge, skills & abilities, and minimum qualifications.

Business unit(s):

COMMN SFMTA SFCCD SFUSD

Standard information

Disaster service work

All City and County of San Francisco employees are designated Disaster Service Workers through state and local law (California Government Code Section 3100-3109). Employment with the City requires the affirmation of a loyalty oath to this effect. Employees are required to complete all Disaster Service Worker-related training as assigned, and to return to work as ordered in the event of an emergency.

Historic and future compensation