Medical Billing Technician GENERAL PURPOSE Under general supervision, assists in the preparation of Medi-Cal billings for District students; verifies student eligibility and information; maintains Medi-Cal billing files and records; and performs related duties as assigned. DISTINGUISHING CHARACTERISTICS Medical Billing Technicians are responsible for obtaining, verifying accuracy and completeness and compiling data on Medi-Cal eligible health care and assessment services provided to District students. Incumbents prepare billings to the State Department of Health Services for health and other support services, ensuring conformance with Medi-Cal rules and regulations applicable to school programs and full reimbursement for all eligible District time and expenses. Medical Billing Technician is distinguished from Accounting Technician by the incumbents’ specialization in health services billing, requiring specialized technical knowledge of medical terminology, school-based health and related support services and Medi-Cal rules and regulations. ESSENTIAL DUTIES AND RESPONSIBILITIES The duties listed below are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to this class. There will typically be an assigned schedule for these duties. 1. Prepares or assists in preparing Medi-Cal billings for reimbursement on direct services, case management and student assessments; collects health logs, rosters, reports, records and other documentation from school sites; verifies students are eligible for Medi-Cal reimbursements to the District; identifies student billable service claims to be billed and compiles and translates data into medical terminology for accurate billing; analyzes billable claims and applies appropriate provider, service and diagnostic codes; researches and reviews confidential files, assessments, reports or medical records for accurate diagnosis or service code; inputs billable claims into County system and submits claims for payment electronically in a timely manner; reconciles explanations of state benefits reports on claims paid by EDS; researches and analyzes denied claims for resubmission for payment; prepares expenditure transfer requests for Medi-Cal payments received on a weekly basis. 2. Verifies student eligibility and information electronically or through automated Medi-Cal system; verifies health and medical log data; notifies nursing staff of student eligibility; identifies discrepancies in student information and contacts school sites to obtain correct information; updates District and County student system and files with correct information. 3. Updates and verifies eligibility of targeted case management (TCM) and individual education plan (IEP) lists and updates the student record system accordingly; prepares and distributes notices to providers for students eligible for Medi-Cal services that are due for case management billing or direct services; tracks providers for timely responses. 4. Maintains complete and accurate records, reports and logs of confidential billing information, including services provided and student information; maintains information on provider credentials and licenses for review by state or federal auditors in conformance with state and federal rules and regulations; pulls student files to be sent to high schools for student leaving the District; boxes records for storage for auditing purposes. 5. Implements and updates the Medi-Cal administrative activities claim plan; collects and submits time surveys from eligible employees for annual Medi-Cal administrative claim plan in a timely and accurate manner; processes incorrect time surveys and resubmits to billing agent for accurate claim plan and complete audit trail; assists in maintaining Medi-Cal budget control. 6. Attends Medi-Cal and Medi-Cal Administrative Activities (MAA) information and training workshops and conferences on updates to Medi-Cal/MAA billing processes; assists in implementation and administration of MAA program; confers with MAA staff on claim plan questions and concerns and sets up appointments for any additional support necessary. 7. Prepares and submits annual reports to Department of Health Services for certification of state matching funds for LEA services. OTHER DUTIES 1. Orders office supplies as needed. QUALIFICATIONS Knowledge of: 1. Medical terminology, equipment and procedures applicable to school-based health and health assessment services. 2. Health and safety regulations applicable to operations of Medi-Cal programs. 3. Laws, regulations, rules and District policies and procedures applicable to areas of responsibility. 4. Methods, practices, documents and terminology used in processing billing transactions and in Medi-Cal billing and recordkeeping. 5. Basic accounting record keeping and internal control policies and procedures. 6. The County’s student system and associated systems, practices and procedures for processing Medi-Cal information and interpreting data. 7. Standard office practices and procedures. 8. Computer equipment and spreadsheet software standard to the District. 9. Principles and practices of customer service and telephone etiquette. Ability to: 1. Operate a computer, calculating machine and other standard office equipment. 2. Organize, set priorities, take initiative and exercise sound independent judgment within areas of responsibility. 3. Perform duties that require high attention to detail and application of rules and specific procedural requirements. 4. Read, interpret, explain, apply and reach sound decisions in accordance with rules, regulations and department procedures. 5. Make calculations and tabulations and review Medi-Cal and related documents accurately and rapidly. 6. Prepare clear and accurate financial records and reports. 7. Communicate clearly and effectively, orally and in writing, using good business English and appropriate terminology. 8. Maintain student health and medical records and prepare reports. 9. Understand and follow written and oral instructions. 10. Maintain confidentiality of District documents and records. 11. Exercise tact, patience and courtesy in dealing with difficult, sensitive and confidential situa¬tions. 12. Establish and maintain effective working relationships with District management, staff, healthcare providers, County employees, private auditors and others encountered in the course of work. Education, Training and Experience: Graduation from high school or G.E.D. equivalent; and three years of progressively responsible experience in preparing and processing medical claims and billings. Experience in a public agency is preferred. Licenses; Certificates; Special Requirements: None. PHYSICAL AND MENTAL DEMANDS The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this class. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical Demands While performing the duties of this class, employees are regularly required to sit; talk or hear, in person and by telephone; use hands repetitively to finger, handle, feel or operate computers and standard office equipment; and reach with hands and arms. Employees are frequently required to walk and stand; and lift up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. Mental Demands While performing the duties of this class, employees are regularly required to use written and oral communication skills; read and interpret data, information and documents; analyze and solve problems; observe and interpret situations; learn and apply new information or skills; perform highly detailed work; work on multiple, concurrent tasks; work with frequent interruptions; work under intensive deadlines; and interact with District management, staff, healthcare providers, County employees, private auditors and others encountered in the course of work. WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this class. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Employees work under typical office conditions, and the noise level is usually quiet.