Requisition No: 846987 

Agency: Department of Health

Working Title: OPS FISCAL ASSISTANT I - 64918106

 Pay Plan: Temp

Position Number: 64918106 

Salary:  $18.00 hourly rate 

Posting Closing Date: 02/25/2025 

Total Compensation Estimator Tool

OPEN COMPETITIVE

Your Specific Responsibilities:

Medical billing filing and posting duties: Runs appropriate HMS system reports including bill file creation/unbilled report for medical claims. Post medical claims in HMS. Audits, analyzes, and reviews superbills for verification of all insurance information; makes the necessary determination as to the correct insurance, and processes all claims accordingly. Research claims for Medicaid, Medicaid HMO’s, Medicare, and other third-party insurance. Contacts insurance carriers when necessary to re-evaluate claims for payment. Processes payments and works denials according to the Accounts Receivable Policy timelines.  Responsible for collaborating with other departments, if necessary. Reviews claims for CPT and ICD-10 codes for accuracy.  Runs appropriate HMS system reports to monitor and evaluate the medical billing process for Medicaid, Medicaid Managed Health care Plans (MMA’s), and Medicare and third-party accounts receivables. Create and Maintain Denied Claims reports on all MMA plans.  Develop training documents (cheat sheets) and on-going training on proper coding and billing which includes understanding modifier, CPT codes and ICD-10 for billing staff. Files complaints to The Agency for Health Care Administration, due to billing issues with MMA Plans.

Eligibility duties for state and federal programs: Determines client’s eligibility for a variety of State and Federal programs. Programs to include but not limited to: Medicaid for pregnant women (PEPW), Healthy Start, Florida Breast and cervical early detection program FBCCEP, Family planning, Sexual transmitted Infection, Prep, Tb, Insulin, Epilepsy and Refugee Health. Interview clients determine economic indigence and type services needs based on Federal poverty level guidelines. Assess the financial status of applicants by verifying income updating in HMS financial screen, to calculate cost of visit. Verifies and updates client demographics. Creates/ updates progress notes on client’s status. Makes proper referral to various related community and service agencies for assistance. Develop training documents (cheat sheets) for position. Reviews and bills Refugee in-house service records weekly. 

Reviews PEPW log, verifies if client has applied for ongoing Medicaid benefits weekly through Florida system. Calls clients to follow-up on Medicaid cases. Closes Medicaid cases for pregnant clients. Enrolls pregnant clients in Healthy start funding for prenatal care.

Contacts clients for Women’s Health clinics and Sexual transmitted disease clinics for reminder appointments. Also instructs clients on necessary documents to provide proof of income for financial eligibility determination needed at their appointment to determine clients sliding fee. Operator for main phone line for county health department.  Answers telephone and transfers to appropriate department as needed.

Required Knowledge, Skills, and Abilities:

Ability to multi-task, FLMMIS, HMS, communication skills, and conduct in-depth interviews for program eligibility. A high school diploma or its equivalent, at least one year of experience working in a clerical setting, medical records, billing/coding and medical office experience preferred.  Knowledge of medical terminology, at least one year of experience working with computers – Microsoft Office preferred. Bilingual Spanish Speaking.  Must be able to lift 20 pounds of medical records.

 

Qualifications:

One year of medical or dental clerical experience.

Knowledge of determining financial eligibility.

Knowledge of processing medic