City and County of San Francisco

Under general supervision, supervises a unit involved in processing health care claims for reimbursement: monitors accounts, bills and reports; interprets, implements and enforces policies and procedures; traces and adjusts bills; assists patients and third party payors; assists the Patient Accounts Supervisor and performs related duties as required. This classification is the first supervisory level in the patient account series.

The classification is responsible for resolving problems in cases assigned to the unit and monitoring, accounts assigned to subordinates. This classification differs from that of the 1663 Patients Accounts Supervisor in that the Patient Accounts Supervisor is responsible for supervising, the entire billing or collections sections of a large billing department whereas the subject classification is only responsible for supervising a unit within one of those sections.

Supervises a staff unit engaged in health care billing.

According to Civil Service Commission Rule 109, the duties specified below are representative of the range of duties assigned to this job code/class and are not intended to be an inclusive list.

1. Provides immediate supervision to a staff involved in processing claims for reimbursement; reviews work of subordinates for complete documentation as required for claims processing; resolves problems in cases assigned to unit; performs related duties such as preparing, employee production reports and timerolls and screening and distributing mail.
2. Using computer reports to identify problem areas, monitors accounts assigned to billing clerks in order to ascertain timely processing; monitors patient accounts transferred from other hospitals; monitors pending Medi-Cal bills for completeness; monitors exception report printout listing accounts in pre-billing stage for correct coding.
3. Assists in implementing new procedures when State and Federal laws governing reimbursement changes interprets relevant Medi-Cal and Medicare regulations; enforces existing business office procedures for claims processing.
4. Traces Medi-Cal reports by analyzing and researching denials of reimbursement either personally or through assignment to subordinates; uses tracer report to verify reasons for unpaid bills; uses restricted access to terminals to make billing adjustments; researches private insurance claims for missing information.
5. Assists patients with forms and questions; assists in all incoming calls or correspondence relating to third party payor inquiries; contacts patients or Department of Social Services for verification of Medi-Cal status contacts auxiliary departments concerning problems involving documentation required for billing.
6. Handles Patient Accounts Supervisor's responsibilities in his or her absences assists supervisor in preparing reports for annual audit.

Knowledge: Requires thorough knowledge of medical claims processing procedures, including complex Federal Medicare, State Medicaid and Universal Billing Forms regulations applicable to hospital and mental health billing; knowledge of the basic principles of accounts receivable, including posting of payments and adjustments of errors prior to billing; familiarity with the basic principles of electronic data processing.

Ability or Skill to: explain complex policies and procedures to a wide variety of people, such as hospital staff and patients; apply billing and collections methods and procedures; supervise the work of subordinates.

These minimum qualifications establish the education, training, experience, special skills and/or license(s) which are required for employment in the classification.  Please note, additional qualifications (i.e., special conditions) may apply to a particular position and will be stated on the exam/job announcement.

Education:

Experience:
Two (2) years of experience billing, claims processing and/or collecting healthcare service reimbursements or medical claims from Medi-Cal (Medicaid), Medicare, insurance, third party payors, and individual payors in a hospital, healthcare agency, or healthcare billing organization.

License and Certification:

Substitution:

SUPPLEMENTAL INFORMATION
PROMOTIVE LINES
From: 1637 Patient Accounts Clerk To: 1663 Patient Accounts Supervisor
ORIGINATION DATE:	01/14/1985
AMENDED DATE:	09/11/19
REASON FOR AMENDMENT:	To accurately reflect the current tasks, knowledge, skills & abilities, and minimum qualifications.
Business unit(s):	COMMN SFMTA SFCCD SFUSD

All City and County of San Francisco employees are designated Disaster Service Workers through state and local law (California Government Code Section 3100-3109). Employment with the City requires the affirmation of a loyalty oath to this effect. Employees are required to complete all Disaster Service Worker-related training as assigned, and to return to work as ordered in the event of an emergency.