1636-Health Care Billing Clerk II

Job description

CITY & COUNTY OF SAN FRANCISCO

DEPARTMENT OF HUMAN RESOURCES

CLASS TITLE: HEALTH CARE BILLING CLERK II

JOB CODE: 1636

DEFINITION

Under general supervision, processes difficult and complex medical claims to Medicare, Medi-Cal, commercial and third-party payors for services provided to patients by the Department of Public Health. This classification is the journey-level class in the series responsible for performing the full range of duties.

DISTINGUISHING FEATURES

The 1636 Health Care Billing Clerk II is distinguished from the 1635 Health Care Billing Clerk I in that the latter processes routine claims and is primarily responsible for reviewing and evaluating claims whereas the 1636 processes all types of claims including those that are difficult and complex.

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. Processes bills and claims for services rendered to patients in order to obtain reimbursement from Medicare, Medi-Cal, commercial, and third-party payors based upon current governmental billing rules and regulations.

2. Evaluates billing documents and claims data for accuracy, completeness and program compliance.

3. Prepares the initial claims and the follow-up claim if necessary by categorizing charges according to the types of medical services provided, completing medical information, verifying that all charges relate to the diagnosis and calculating the charges and benefits according to regulations.

4. Spends down Medi-Cal share of cost in order to certify monthly coverage to allow processing of claims.

5. Posts payments received from various payors, including Medicare, Medi-Cal, commercial, and third-party payors.

6. Sends Claims Inquiry Forms (CIFs), appeals, and tracers on unpaid accounts at predetermined intervals.

7. Researches questions and denials and provides assistance to patients, physicians, insurance and legal representatives, fiscal intermediaries and other regarding claims reimbursement and coverage.

8. Produces reports relevant to billing and claims activities using electronic databases.

KNOWLEDGE, SKILLS, AND ABILITIES

Knowledge of: Medical claim processing for reimbursement from Medicare, Medi-Cal, commercial, and third-party payors; medical terminology; modern office practices and procedures; Medicare and Medi-Cal rules and regulations, including Short-Doyle Medi-Cal system; payment posting procedures.

Ability or Skill to: Perform detailed clerical work in a methodical and thorough manner with speed and accuracy; read and analyze a medical chart; deal courteously and effectively with a variety of people; perform basic math; and 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:

One (1) year of experience billing, claims processing and/or collecting healthcare services reimbursements or medical claims from Medi-Cal (Medicaid), Medicare, insurance, third-party payors, and individual payors in a hospital, healthcare agency, or healthcare 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: 1637 Patients Accounts Clerk

From: 1635 Health Care Billing Clerk I

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