Health Care Billing Clerk 1 - Access to City Employment (ACE) (1635)
Published: April 14, 2023
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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.
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. Reviews, evaluates, and processes bills for services rendered to patients in order to obtain reimbursement from various insurance carriers and government programs. 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. Prepares the claims forms by completing the information required and categorizing the billing charges by grouping them according to types of medical services provided. Reviews electronic and lockbox payments and posts to corresponding accounts. Researches questions and concerns, and provides assistance to patients, physicians, insurance and legal representatives, and others regarding claims reimbursement and coverage. 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.
How to qualify
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.
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 payers, and individual payers in a hospital, healthcare agency, or healthcare billing organization.
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.
What else should I know?
Notes: 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
Conviction History: As a selected candidate for a job, you will be fingerprinted, and your fingerprints will be sent to the California Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI). The resulting report of your conviction history (if any) will be used to determine whether the nature of your conviction (or arrest, in limited circumstances) conflicts with the specific duties and responsibilities of the job for which you are a selected candidate. If a conflict exists, you will be asked to present any evidence of rehabilitation that may mitigate the conflict, except when federal or state regulations bar employment in specific circumstances, such as: Candidates for positions with the Unified School District and the Community College District may be disqualified from consideration should their conviction history not meet the standards established under the California Education Code. Candidates for positions with the Recreation and Park Department may be disqualified from consideration should their conviction history not meet the standards established under California Public Resources Code 5164. Having a conviction history does not automatically preclude you from a job with the City. If you are a selected candidate, the hiring department will contact you to schedule a fingerprinting appointment.
Disaster Service Workers: 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.
CONDITION OF EMPLOYMENT: All City and County of San Francisco employees are required to be fully vaccinated against COVID-19 as a condition of employment. Someone is fully vaccinated when 14 days have passed since they received the final dose of a two-shot vaccine or a dose of a one-shot vaccine. Any new hire must present proof of full vaccination status to be appointed. Any new hire who will be routinely assigned or occasionally enter High-Risk Settings, must provide proof of having received a COVID-19 booster vaccine by March 1, 2022, or once eligible.
The City and County of San Francisco encourages women, minorities and persons with disabilities to apply. Applicants will be considered regardless of their sex, race, age, religion, color, national origin, ancestry, physical disability, mental disability, medical condition (associated with cancer, a history of cancer, or genetic characteristics), HIV/AIDS status, genetic information, marital status, sexual orientation, gender, gender identity, gender expression, military and veteran status, or other protected category under the law.