This experienced employee represents the City of Cincinnati to customers and (deals with patients, billikng and coding. The individual is responsible for processing, generating, maintaining medical/dental billing; verifying patient information and demographics. In addition this role is charged with the important tasks of maintaining and obtaining required paperwork for processing medical/dental claims from health center services. Employee interacts with customers in person, by telephone, by e-mail, or in writing while maintaining a high level of customer satisfaction. Employee performs more complex customer service tasks, including determining proper course of action for billing activities, authoring correspondence, researching and analyzing complex customer issues, and assisting supervisor with customer calls and issues referred for supervisor intervention. Employee may be assigned special projects and investigations. Performs related duties as required.

(Illustrative only. Any one position may not require all of the listed KSAs nor do the listed examples include all the KSAs which may be required.)

Knowledge of:
Medical and dental billing (i.e., ICD-10 codes, ICD-9-CM, CPT and CDT codes and can translate CDT codes to CPT and ICD-9-CM codes.
Medicare and Medicaid billing procedures and regulations, State and Federal program obligations, sliding fee scale, and private insurance billing practices.
Principles and practices of mathematics.
Principles of business letter writing and report preparation.
Problem solving techniques Methods needed to gather relevant information from callers by asking appropriate questions.
City of Cincinnati services and functions in order to refer complaints to the appropriate department or agency.
Federal bankruptcy laws and related collection activities.
Software applications used for customer service and billing functions.
Safety policies and procedures, e.g., Employee Safety Instruction Manual and applicable agency requirements.

Skill to:
Operate a computer utilizing the appropriate software related to assigned area of responsibility.
Operate assigned vehicle.
Input appropriate data into computer system utilized.

Ability to:
Communicate effectively orally and in writing.
Interpret and communicate to the public, City of Cincinnati policies and procedures, including the ability to match the appropriate policies and procedures to the particular jurisdiction for each call.
Prepare clear and concise reports.
Listen effectively.
Interpret unclear or complex information and instructions.
Determine the nature of a problem based on the caller's information and to make decisions concerning referral of messages with limited information.
Research, investigate, and analyze issues as they occur.
Organize work and follow directions, both oral and written.
Read and interpret information provided in reference manuals, on computer printouts and spreadsheets and in staff meetings.
Empathize with customers and communicate clearly in layman's terms. Handle difficult customers or situations in a calm and professional manner.
Perform mathematical calculations. Work in a fast paced environment.
Self- direct work within guidelines provided by supervisor.
Apply problem solving techniques.
Provide information and feedback to supervisor as needed for process development and improvement.
Work independently.
Use good judgment.
Train and direct others.

Examples of Work Performed:
(Illustrative only. Any one position within this classification may not include all of the duties listed nor do the listed examples include all of the tasks which may be performed.)

Answers incoming calls from citizens, medical/dental business customers, other City Departments and other agencies.
Receives complaints and requests, provides information, analyzes data to determine proper response to inquiries, responds to inquiries, and/or directs citizens to proper department for assistance.
Resolves difficult or sensitive customer service inquiries or problems; advises public on complex rules, policies, and procedures.
Collects patient's chart, pulls up information on the computer; confirms it is the correct patient and the insurance information is accurate; checks for current consent for treatment form; checks for proof of income and or insurance.
Answers patient medical/dental billing inquiries.
This includes contacting patients regarding balances due and sending appropriate time-based collection letters, eventually following through to collections if necessary.
Codes and submits claims electronically and manually.
Posts payments. Works through denied/rejected claims.
Reconciles accounts.
Works Patient Balance Reports and Provider Aging Reports.
Manages aged patient accounts.
Ensures the management of patient information, insurance verification, prior authorizations and appeals, and medical/dental billing collection; identifies, corrects, and reports coding problems; resolves coding edits and denials in a timely manner; and identifies opportunities to reduce denials and enhance revenue.
Makes decisions on actions needed to resolve customer billing and service issues and concerns; initiates service investigations and interprets results and recommends next steps.
Provides customers information on bills, account balances, services, delinquent accounts, and adjustments; explains bills and billing calculations.
Maintains confidentiality of information according to the HIPAA Act of 1996.
Provides customers with as much information and direct services as possible without referring the customer to another person.
Receives complaints and requests, provides information, analyzes data to determine proper response to inquiries, responds to inquiries, and/or directs citizens to proper area of health center for assistance.
Provides information and assistance related to health center services, activities, procedures, or other issues; responds to questions, complaints, or requests for service, and resolves customer inquiries relating to billing, billing adjustments, and/or other issues regarding health center services.
Answers incoming calls from patients; prioritizes calls received.
Researches, analyzes, and resolves customer's problems and inquiries.
Operates a computer to input information from patient and to access patient records; creates, edits, compiles, manipulates, and retrieves files, databases, and create reports. Takes and relays messages to doctors, nurses, supervisors, and other personnel by personal contact, e-mail, or telephone.
Retrieves customer account information to ascertain bill payment history.
Provides customers information on bills, account balances, services, delinquent accounts, and adjustments; explains bills and billing calculations.
Updates customer files; verifies accuracy of account files against various sources of information.
Determines if and when to grant bill extensions and extended payment arrangements; listens to circumstances and determines if supervisor's approval of extension is needed.
Updates customer files; verifies accuracy of account files against various sources of information; works from quality assurance reports to correct data in customer billing and information system.
Working knowledge of current safety policies, instructions for proper usage, and other procedures and professional practices required for completing job duties. Identifies unsafe practices and conditions and brings such matters to the attention of the supervisor.
Conveys a positive image and handles a large volume of customers in a friendly, effective, efficient, and professional manner.

RESUME, BILLING/MEDICAL CODER CERTIFICATION, AND A VALID DRIVER'S LICENSE MUST BE ATTACHED TO YOUR ONLINE APPLICATION OR APPLICATION WILL BE REJECTED.

Each applicant must be Certified Billing/Medical Coder and have three years of experience as a Certified Medical/Dental Billing Coder.

OTHER REQUIREMENTS
Must have a valid Driver's License.