Medical Billing Technician

Position Summary

Tillamook County follows Oregon Pay Equity laws in reviewing education, experience and seniority for wage offers. This recruitment will remain open until filled. Incumbents in this classification combine a practical accounting knowledge with procedural expertise to manage insurance claims billing, address patient and provider inquiries, and resolve billing issues for specific Health Department programs. Responsibilities include collaborating with external billing partners, utilizing the EHR system to release, update coding and diagnosis codes or adds notes, supporting audits, and staying informed on billing changes and new programs.

Qualifications

The individual in this role is expected to possess and exhibit the following knowledge, skills, and abilities.

Knowledge

• Detailed knowledge of principles and practices of billing and accounts receivable record keeping
• Knowledge of financial and healthcare terminology
• Knowledge of healthcare computerized information systems and spreadsheet software
• Knowledge of office practices, procedures and equipment
• Thorough understanding of the Billing Cycle.
• Thorough understanding of insurance types, including commercial, Medicaid, Medicare, Advantage, marketplace, military, and distinctions between in-network and out-of-network plans.

Skills

• Skill in using computers and a variety of accounting software.
• Medical insurance claim analyst skills and experience
• Medical back-office experience with strong computer skills in MS Office, Word, Excel
• Good interpersonal and customer relations skills.
• EPIC software and Electronic Medical Records experience.
• Skill in navigating insurance websites effectively.
• Strong phone communication skills.

Abilities

• Ability to use nonstandard procedures and techniques to resolve unusual problems or address management requirements.
• Ability to use initiative and judgment in completing tasks and responsibilities.
• Ability to courteously meet and deal effectively with other employees, agency representatives, vendors, contractors, the public, and others.
• Ability to solve complex problems, demonstrating strong puzzle-solving skills.
• Ability to learn, adapt to changes, and conduct effective research.

Required Qualifications (Minimum qualifications for this role)

Education

• High School diploma or equivalent.
• Coursework in medical office occupations or business administration preferred.
• Equivalent experience may be substituted for educational requirement. Amount of additional experience acceptable: Two (2) years.

Experience

• Computer applications including CPT, ICD-9, ICD-10, and HCPCS coding experience.

Certifications or Licenses (if applicable)

• N/A

Preferred Qualifications (if applicable)

• Certified Medical Coder preferred but not required.

Other Qualifications (if applicable)

• Must pass a pre-employment criminal history background investigation.

Essential Duties

Duties assigned to this classification include, but are not limited to, the following examples.

• Oversees preparation and submission of the Health Department's FQHC clinical services billing and reimbursement requests to private individuals, private insurers and governmental entities including Medicare, Medicaid, etc.
• Submit claims for specific Health Department programs, including Targeted Case Management (TCM), Screenwise, VA, MVA, WC, and Dental services. Ensure claims are accurate and meet program requirements.
• Resolve claims with errors or missing information by managing Work Queues in the EHR system (Epic)
• Collaborate with external vendors and partners, including an outside billing company (OBS) and LabCorp, to address coding problems and billing issues. Provide customer and staff support by answering calls and emails related to billing questions, quotes for services, or claim inquiries.
• Update the Health Department's Fee Schedule in Epic to reflect current charges.
• Enter and manage JIRA tickets to request IT fixes and improvements for the EHR system.
• Send daily EFT and SPHERE payment information from the clearinghouse to the Treasury Department.
• Assist with audits, special projects, and report preparation for managers.
• Stay informed about billing changes and new programs by conducting research and self-directed training.

Performs additional duties as assigned.

Supplemental Information

Supervisory Responsibilities

• Not a supervisory role but provides informal training/orientation to volunteers, or newly assigned personnel.

Supervisory Controls

• Works independently within a broad framework, managing a complex area of responsibility. The supervisor provides direction on overall goals, and performance is reviewed periodically based on outcomes and expected results.

Working Conditions

Mental effort

• Usually, normal concentration and deadlines with occasional periods of sustained deadline pressure.

Physical effort

• Minimal: The work is sedentary. Typically, the employee sits comfortably to do the work. However, there may be some walking; standing; bending; carrying of light items, such as papers, laptop bag, or small parts; or driving an automobile. No special physical demands are required to perform the work.

Work environment

• Everyday Risks/Discomforts: require normal safety precautions typical of such places as offices, meeting and training rooms, libraries, and commercial vehicles, e.g., use of safe work practices with office equipment, avoidance of trips and falls, observance of fire regulations and traffic signals. The work area is adequately lighted, heated, and ventilated.