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CAREER DESCRIPTION Sr. Medical Billing Specialist SALARY INFORMATION In addition to performance-based merit increases, this position is scheduled to receive a salary range increase on the following date: Effective June 28, 2024 - 4.25% increase Effective June 27, 2025 - 4.00% increase Salary may be negotiable within the range listed above, based on position requirements and successful candidate's qualifications, subject to appropriate authorization. OPEN TO THE PUBLIC This recruitment will establish an open eligible list. The eligible list established through this recruitment will be used to fill current/future vacancies in Auditor-Controller and/or any other agencies within the County of Orange. This recruitment may also be used to fill positions in similar and/or lower classifications. DEADLINE TO APPLY Qualified applicants are encouraged to apply immediately, as the recruitment will close on MON DAY, OCTOBER 02, 2023 at 11:59 PM (PST). ORANGE COUNTY Orange County is a desirable place to live - and is one of the premier employers in the region, as well as the third largest populated County in California. At the County you will find variety, individual opportunity, job satisfaction, and the pleasure of working with colleagues who are dedicated to making a positive difference. You can learn more about the County of Orange by clicking here . AUDITOR-CONTROLLER The Auditor-Controller Department is committed to serving Orange County by ensuring accountability over public spending, transparency of Taxpayer dollars, and engaging the public in government. We carry out our vision and mission by conducting the Public's business with the highest ethical and due diligence standards by supporting ethical and responsible financial decisions throughout the County. You can learn more about the Auditor-Controller Department by clicking here . HEALTH CARE AGENCY Health Care Agency Accounting is part of the Satellite Operations Division of the Auditor-Controller Department that is responsible for providing accounting support services to the Orange County Health Care Agency (HCA) Department. The Medical Billing Unit, within the HCA Accounting Division, ensures that HCA is billing in compliance with federal and state guidelines and all billing deadlines are met and revenue collection is not jeopardized. The Medical Billing Unit supports all the coding, billing and collections activities on behalf of HCA. You can learn more about the Health Care Agency by clicking here . THE OPPORTUNITY The Sr. Medical Billing Specialist is responsible for processing and submitting claims/bills to Medicare, third-party health plans and clients for services provided by HCA’s mental health and recovery as well as substance use disorder services, in compliance with state/federal regulations. The Sr. MBS communicates with culturally diverse clients in resolving past due accounts for mental health and substance use disorder services. Collaborates with HCA program employees in the recalculation of annual fees (Universal Method of Determining Ability to Pay - UMDAP) due to a change in the financial position of a client. Reconciles client accounts to accurately reflect the correct balance due once the UMDAP has been determined. Prepares supporting documents for small claims court. Acts as a representative in small claims court on behalf of Orange County Health Care Agency, answering questions presented by the judge or negotiates a settlement with the client, prior to the hearing. The Sr. Medical Billing Specialist will perform claims follow up duties; researching claims not paid or underpaid claims, taking actions necessary. All HCA Accounting positions are assigned to the Auditor-Controller’s satellite accounting team at the Health Care Agency. MINIMUM QUALIFICATIONS AND CORE COMPETENCIES One year of experience as a Medical Billing Specialist with the County of Orange. Or Two years of experience preparing and processing electronically-generated medical billing, preferably in a hospital, medical office, or public health setting. Education in the areas of medical billing, accounting, office services procedures or medical terminology may be substituted for up to six months of the required experience on the basis of one semester unit for one month of experience. In addition to the minimum qualifications, the ideal candidate will demonstrate experience and/or training in the following areas below: Technical Expertise Thorough knowledge of Medicare, Medi-Cal and third-party commercial insurance billing guidelines and regulations Thorough knowledge of Reasonable Collection Effort guidelines Understanding of follow-up collection and pre-collection activities Reconciling complex client accounts using basic accounting principles Knowledge of medical terminology and/or Current Procedural Terminology (CPT) International Classification of Diseases (ICD) Experience with Microsoft Excel and Word, and medical billing systems Knowledge of Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Practices and HCA Policy Understanding of policies, rules, and regulations regarding County procedures Analysis/Problem Solving Analyzing complex client account balances for accuracy Identifying bad debt accounts through work queues and/or reports Identifying reasons of claims that are denied, unpaid or underpaid Identifying and successfully resolving complex issues and problems efficiently Reviewing claims and determining eligibility for payment Effective Communication Effective and empathetic verbal communications skills Interpreting detailed and complex information and explaining to people who are unfamiliar with it Strong ability to effectively communicate complex rules and regulations to the public, vendors, or those unfamiliar with county procedures Excellent oral and written communication skills are required Communicating with customers when a claim is denied or incomplete, and follows through on pending issues to accomplish resolution MINIMUM QUALIFICATIONS Please click here to be directed to the class specification for full details regarding the minimum qualifications for the Sr. Medical Billing Specialist. NOTE: Foreign degrees require an evaluation of U.S. equivalency by an agency that is a member of the National Association of Credential Services (N.A.C.E.S.). RECRUITMENT PROCESS Human Resource Services (HRS) will screen all application materials to identify qualified applicants. After screening, qualified applicants will be referred to the next step and notified of all further procedures applicable to their status in the competition. Application Screening (Refer/Non-Refer) Applications and supplemental responses will be screened for qualifications that are highly desirable and most needed to successfully perform the duties of this job. Only those candidates that meet the qualifications as listed in the job bulletin will be referred to the next step. Structured Oral Interview | SOI (Weighted 100%) Applicants will be interviewed and rated by an oral interview panel of job knowledge experts. Each applicant's rating will be based on responses to a series of structured questions designed to elicit the applicant's qualifications for the job. Only the most successful candidates will be placed on the eligible list. Based on the Department's needs, the selection procedures listed above may be modified. Candidates will be notified of any changes in the selection procedures Veterans Employment Preference Policy (VEPP) The County is committed to providing a mechanism to give preferential consideration in the employment process to veterans and their eligible spouses and will provide eligible participants the opportunity to receive interviews in the selection process for employment and paid internship openings. Please click here to review the policy. Eligible List Once the assessment has been completed, HRS will establish an eligible list of candidates. Candidates placed on the eligible list may be referred to a selection interview to be considered for present and future vacancies. ADDITIONAL INFORMATION Please see below for important information regarding COVID-19 related requirements. Effective April 3, 2023, it is strongly recommended that County employees working in health care settings and correctional facilities follow vaccination and booster guidelines provided by the California Department of Public Health (CDPH) and the Centers for Disease Control and Prevention (CDC). Please click here to see the latest guidance for more details. EMAIL NOTIFICATION: Email is the primary form of notification during the recruitment process. Please ensure your correct email address is included in our application and use only one email account. NOTE: User accounts are established for one person only and should not be shared with another person. Multiple applications with multiple users may jeopardize your status in the recruitment process for any positions for which you apply. Candidates will be notified regarding their status as the recruitment proceeds via email through the GovernmentJobs.com site. Please check your email folders, including spam/junk folders, and/or accept emails ending with "governmentjobs.com" and "ocgov.com." If your email address should change, please update your profile at www.governmentjobs.com . FREQUENTLY ASKED QUESTIONS: Click here for additional Frequently Asked Questions. For specific information pertaining to this recruitment, please contact Sam Apraku at 714-834-3116 or at Samuel.Apraku@ac.ocgov.com EEO INFORMATION Orange County, as an equal employment opportunity employer, encourages applicants from diverse backgrounds to apply. Non-Management Benefits In addition to the County's standard suite of benefits, such as a variety of health plan options, annual leave and paid holidays--we also offer an excellent array of benefits such as a Health Care Reimbursement Account, 457 Defined Contribution Plan and Annual Education and Professional Reimbursement. Employees are provided a Retirement Plan through the Orange County Employees Retirement System (OCERS). Please go to the following link to find out more about Defined Benefit Pensions and OCERS Plan Types/Benefits. http://www.ocers.org/active-member-information Click here for information about benefits offered to County of Orange employees. Closing Date/Time: 10/2/2023 11:59 PM Pacific

Grievance Resolution Specialist, Sr. (Member Resolution) Job Description Department(s): Grievance & Appeals Resolution Services (GARS) Reports to: Supervisor Grievance and Appeals FLSA status: Non - Exempt Salary Grade: H - $59,000 - $89,782 Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is on Tuesday , August 15, 2023 at 11:59 PM. Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. About CalOptima Health CalOptima Health is the single largest health plan in Orange County, serving 880,000 members, or one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. If you're looking for an opportunity to work for an organization dedicated to improving local health care and serving the needs of the most vulnerable, we encourage you to join CalOptima Health. About the Position The Grievance Resolution Specialist Sr (Member Resolution) will coordinate the overall process of complaint resolution, respond to all verbal and written complaints from members and/or providers related to member eligibility and benefits, contract administration, claims processing, utilization management decisions, pharmacy and vision decisions. The incumbent will have frequent external contact with members and families, health care providers, organizations and regulators. In addition, the incumbent will interact with internal contacts in Claims Administration, Customer Service, Provider Relations, Contracting, Pharmacy Management, Third Party Administrators (TPA), Medical Management, health networks and other resources to identify factors necessary for the optimal resolution of complaints. The incumbent will be responsible for processing complex cases requiring additional research or problem-solving. The incumbent must have knowledge and understanding of the Department of Health Care Services (DHCS) and Centers for Medicare & Medicaid Services (CMS) guidelines and regulations that are necessary and required to process member complaints. Duties & Responsibilities: Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Assists the GARS management team in carrying out, monitoring and providing oversight of daily inventory reporting, which includes, but is not limited to, daily, weekly and monthly reports. Develops and maintains adequate information systems to ensure timely and effective data collection, summarization, integration and reporting which includes, but is not limited to, case creation, management and events/activity tracking. Ensures compliance with CalOptima Health's Grievance Policy and timely case resolution, initiates and coordinates referrals to the Quality Improvement department as necessary and facilitates response to members according to policy. Gathers pertinent information regarding complaints, including, but not limited to, member or provider concerns, claims payments, billing reimbursements, supporting information related to initial decisions, new information supporting complaints and supplemental information required to evaluate complaints and regulatory requirements. Coordinates and participates in case discussion with operational experts to result in a final case disposition. Evaluates case details related to member complaints and makes appropriate decisions based on information provided and research conducted. Trains new and existing staff, assists in case assignment, takes on case assignment per business needs and oversees the day-to-day operations for member and provider complaints and monitors for compliance in the implementation of the decision. Contacts appropriate parties to request and obtain missing information and supporting documentation, or provide education as needed. Oversees resolution letters for the accuracy of the information and appropriate decisions. Meets performance measurement goals for GARS. Consistently meets the internal monthly Scorecard standards with minimal case findings. Attends meetings on issues related to case assignments as well as meetings with various departments to keep an up-to-date understanding of organizational processing and guidelines to effectively resolve cases. Assists with handling escalated issues from internal and external customers. Tracks and trends member grievance issues. Supports all department initiatives in improving overall efficiency. Assists with member grievance audits by reviewing findings, gathering and organizing requested materials and potentially completing rebuttals. Completes other projects and duties as assigned. Experience & Education: High School diploma or equivalent required. 3 years of experience with Grievance and Appeals, specifically in the member grievance competent required. An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying. Preferred Qualifications: Associate's degree in Business, Health Care Administration or related field. Experience with Medicare or Medi-Cal member appeals, and denials process. Physical Demands and Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes, up to 25 pounds Employee must be able to communicate, particularly for regular phone use, in meetings and face-to-face interaction. Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures; there are steps and elevators available to access the work areas. All floors have keypad controls for the safety of the employee. About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4349 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-4b66de92c2eaaa4ab568b5336eae2325