MEDICAL BILLING TECHNICIAN

Job Specifications

Class Code: CH4
Analyst: JML
Date Originated: 1/04
Date Revised: N/A

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 Accounting Technician in that positions in the latter class require greater knowledge of accounting principles and practices, are not restricted to the field of medical billing, and the nature of the assigned responsibilities is such that large numbers of personnel must rely on incumbents to adequately accomplish their own technical and administrative responsibilities.

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:

Working knowledge of:

Ability to:

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