Medical Billing Specialist I/II

Position Description Medical Billing Specialist I - $23.39-$28.76 Medical Billing Specialist II - $25.79-$31.70 Join a Team That Makes Every Dollar Count for the People We Serve Behind every successful behavioral health program is a strong team ensuring services are accurately documented, billed, and reimbursed so care can continue. At Calaveras County Behavioral Health, our Medical Billing Specialists play a vital role in supporting access to mental health and substance use disorder treatment by helping maximize reimbursement, maintain compliance, and protect the financial resources that allow our programs to grow. As California's behavioral health system continues to transform through CalAIM, the Behavioral Health Services Act (BHSA), Enhanced Care Management (ECM), Community Supports (CS), Justice Involved services, BH-CONNECT, and expanded housing initiatives, our billing professionals have become more important than ever. This position goes far beyond traditional medical billing—you will work closely with clinicians, fiscal staff, managed care plans, hospitals, and community partners to ensure accurate claims, resolve billing issues, reconcile payments, and support the financial sustainability of services that change lives. We're looking for someone who enjoys solving problems, pays close attention to detail, thrives in a collaborative environment, and takes pride in knowing that their work directly supports individuals and families throughout Calaveras County. At Calaveras County Behavioral Health, we believe every role contributes to our mission of helping people live healthier, more independent, and more hopeful lives. If you're looking for meaningful work where your knowledge, initiative, and dedication truly make a difference, we'd love to have you join our team. Under general direction, to perform specialized clerical work in connection with processing and billing fiscal intermediaries for medical services rendered to patients; and to do other work as required for Behavioral Health Services. Distinguishing Characteristics Medical Billing Specialist I This is an entry-level classification in the Medical Billing Specialist series; incumbents will be expected to perform more routine duties while gaining additional experience and familiarity with departmental policies and procedures. This position is responsible for working with medical billing documents, reviewing and verifying insurance accounts against third party billing program provision and procedures. Incumbents in this class are expected to solve routine problems without assistance while unusual problems are referred to a supervisor. Medical Billing Specialist II This is the Journey-level classification in the Medical Billing Specialist series; Incumbents will be expected to perform more technical duties related to medical billing functions. This position is responsible for working with medical billing documents, reviewing and verifying insurance accounts against third party billing program provision and procedures; interpreting policies, rules, or regulations on billing related matters and/or assisting in the coordination of procedures among various patient accounts systems. Incumbents in this class are expected to solve routine as well as highly complex problems without assistance. Example of Duties Medical Billing Specialist I Check and correct bills and accounts for numerical accuracy and proper coding, and prepare paperwork for data entry. Input service claims into Electronic Health Record billing system. Verify billing account or insurance forms for completeness and accuracy against a variety of automated and manual records. Review patient accounts to determine the accuracy of account information and make any required adjustments for proper billing purposes. Review monthly paid, denied and rejected claims for Medi-Cal and third party insurance companies. Process denied claims through Electronic Rebill System if applicable for reimbursement. Prepare self-pay bills; close charges for pay client accounts; review bills for accuracy. Post payments received from various funding sources. Process explanation of benefits when additional information from payer sources is requested. Assist department in training, implementing and complying with federal electronic health mandates. Update client data including admission/discharge, CSI reporting, diagnosis, and financial eligibility. Track and reconcile daily time studies for department staff and contract workers. Act as resource or subject matter expert for Electronic Health Record system. Submit data on Behavioral Health Information Systems (BHIS); prepare and transmit Medi-Cal Electronic Billing submittals to Department of Healthcare Services through the BHIS. Prepare HCFA billing to third-party insurances, including Medicare. Medical Billing Specialist II In Addition To Above Investigate and reconcile denials from private insurance. Investigate and reconcile denials from Medicare Process Medi-Cal denials. Process Medi-Cal provider certifications. Works independently with third party Electronics Health Record personnel. Independently Submits data on BHIS; prepare and transmit Medi-Cal Electronic Billing submittals to Department of Mental Health through the BHIS. Independently processes the medical disallowances and voids and replaces claims. Interviews clients to set up financial payment plans. Handles work of a complex nature related to medical billing. Prepares and presents reports related to claims. Assumes responsibility for ensuring that internal controls are applied to medical billing activities per departmental policies. Provides training to staff regarding the Electronic Health Record and Specialty Mental Health and Substance Abuse Billing Identifies procedural needs and drafts policies Minimum Qualifications Medical Billing Specialist I Basic methods, practices, and terminology of fiscal clerical work including basic billing methods, procedures, and techniques; basic clerical auditing and verification techniques; medical terminology, and billing forms. Medical Billing Specialist II Advanced methods, practices, and terminology of fiscal clerical work including advanced billing methods, procedures, and techniques; general clerical auditing and verification techniques; computerized accounting and medical billing systems, medical terminology, and billing forms. Ability To Medical Billing Specialist I Understand and apply rules and regulations pertaining to medical billing policies and procedures while identifying routine billing errors and differentiate between appropriate applications of various billing methods; perform basic arithmetic computations rapidly and accurately and post the results on accounting records; organize work to meet prescribed deadlines; operate automated keyboard equipment; follow oral and written directions. Medical Billing Specialist II Understand and apply rules and regulations pertaining to medical billing policies and procedures while identifying complex billing errors and differentiate between appropriate applications of various billing methods; perform advanced arithmetic computations rapidly and accurately and post the results on accounting records; organize work to meet prescribed deadlines; operate automated keyboard equipment; follow oral and written directions; identify and respond to procedural and policy development requirements. Training And Experience Medical Billing Specialist I Equivalent to graduation from high school and two years’ experience performing financial, statistical, or fiscal record keeping functions with at least one year involving third party intermediary medical billing. Medical Billing Specialist II Equivalent to graduation from high school and three years’ experience performing financial, statistical, or fiscal record keeping functions with at least one year involving third party intermediary medical billing. Special Requirements Possession of an appropriate California operator’s license issued by the State Department of Motor Vehicles may be required. Program Highlights Down Payment Assistance, up to 5.5% of the Total Mortgage Loan. Available with purchase of a primary residence. Variety of Mortgage Loan options (FHA, VA, USDA and Conventional Mortgage Loans). No first-time homebuyer requirement to qualify. Flexible guidelines: Minimum FICO 640; Maximum DTI 50%. Flexible income limits, up to moderate income levels; no income limits for FHA and VA. For more information, vists Calaveras County Assist-to-Own Boot Allowance: $150 or $175 per year and is distributed once a year, in the first full pay period in the month of December. Uniform Allowance: $600 per calendar year split into monthly payments. Payments will be made monthly on the second pay check. Extra-Hire Extra-hire employees are not eligible for step advances, vacation, seniority rights, holiday pay or other certain employee benefits. They are entitled to 24 hours of sick leave per year and eligilbe for the county's CORE Medical plan but not eligible for dental or vision insurance. Vacation Days 0 - 3 complete years = 80 hours per year. After 6 months you can take your first week. 3 – 10 complete years = 120 hours per year 10 years+ = 160 per year Holidays 14 paid holidays per year. Life Insurance through ReliaStar: $50,000.00 County paid. After 65 years of age, pays out 65%, after 70 years of age ReliaStar pays out 32.5%. Sick Leave: 12 days annual sick leave accrual with unlimited accumulation. Sick leave is accrued at 3.69 hours for each full 80 hours of payroll period. 60 hours of sick leave can be used for immediate family, parent spouse, child or sibling. Merit: After successfully completing twenty-six (26) pay periods, a 3.5% merit increase may be granted. Merit increases may be granted annually thereafter to the top step. Probation Period: New employees remain in a probationary status for 26 pay periods. Longevity Incentives @ 2.5% for each of the following: 5.5 years (if hired before March 28, 2005) 6 years 10 years 15 years 20 years 25 years Bi-Lingual pay: $75 per month for specific approved job classifications. Flexible Spending: Pre-Tax Medical Reimbursement – Max contribution of $2,500 annually Flexible Spending: Pre-Tax Dependent Care Account – Max contribution of $5,000 annually Section 125 Plan Additional insurance is available through the Section 125 plan and may be purchased from a representative during open enrollment or by appointment when they are on-site.

AFLAC

Heart & Stroke Insurance Cancer Insurance Accident Insurance Universal Life Insurance Short Term Disability Insurance

LEGALSHIELD

CalPERS CALPERS RETIREMENT INFORMATION: CLASSIC MEMBERS: 2% at 55 PEPRA MEMBERS: 2% at 62 Extra-Hire's will be enrolled into Public Agency Retirement System (PARS) unless you are already a member of CalPERS. Additional Retirement Plan The County offers a 457 Government plan. Employees can contribute u to this deferred compensation plan (Pre or Post Tax options). The County utilizes VALIC. Participating employees will receive a County paid match of up to $50 a month. #J-18808-Ljbffr City of Santa Fe Springs