Insurance Audit Specialist

FRESNO COUNTY SUPERINTENDENT OF SCHOOLS

CLASSIFIED POSITION

JCN:117

RANGE: 142

NON-EXEMPT

INSURANCE AUDIT SPECIALIST

BASIC FUNCTION:

Under the direction of an assigned supervisor, perform professional accounting work involved in analyzing, auditing, and adjusting insurance accounts and claims for the All4Youth Department at the office of the Fresno County Superintendent of Schools (FCSS); review, process, and verify a variety of insurance-related financial information, reconciling and maintaining records; prepare and analyze various worksheets to ensure accuracy and compliance with FCSS and applicable insurance regulations and policies.

REPRESENTATIVE DUTIES:

ESSENTIAL DUTIES:

• Analyze insurance policy data, claims data, and financial records to identify discrepancies, errors, or potential fraud; identify overbilling and underbilling activities related to claims; identify trends and provide statistical insights to leadership to enhance processes and practices

• Assemble, match, sort, tabulate, check and post a variety of financial and statistical data such as income and expenditures to appropriate accounts; perform auditing procedure to review data for accuracy and completeness; reconcile financial statements with accounting records and reports.

• Assist in training and provide technical support to internal and external partners as assigned.

• Assist with updating manuals and other documents used by personnel for insurance claims processing and audit procedures.

• Communicate with internal and external partners, the public, vendors, insurance agents, policy holders, and various outside agencies to exchange information, coordinate activities, clarity audit findings, and resolve issues or concerns.

• Input variety of financial data into an assigned computer system; maintain automated records and files; initiate queries, manipulate data and generate a variety of computerized records and reports as assigned; audit input and output data for accuracy and completeness.

• Perform a variety of technical accounting duties in the review, analysis, and adjustment of assigned district financial accounts; transfer funds as appropriate; review, adjust and ensure accuracy of transfers.

• Perform professional audits and review selected insurance transactions to ensure compliance with applicable laws, codes, rules, regulations, policies, procedures, and Generally Accepted Accounting Principles (GAAP), as assigned.

• Process accounts receivable according to established county office procedures as assigned; review patient billing and insurance claims to ensure revenue is received in a timely manner; adhere to the revenue cycle processes.

• Provide business support, technical assistance and training and assistance to internal and external partners concerning accounting functions, systems, and related functions; respond to inquiries and provide detailed and technical information concerning related practices, procedures, standards, requirements, and techniques with Availity, Smartcare, etc.

• Research, compile, prepare and revise accounting data regarding assigned accounts; prepare and maintain a variety of auditable financial records, reports and files related to assigned accounts, income, expenditures, transfers, statements, balances and assigned activities.

• Review and audit claims related to behavioral health and mental health services; ensure accurate coding, billing and compliance.

• Review, process, code and verify a variety of financial information related to assigned accounts; audit accounts for errors and make appropriate adjustments; compare and evaluate financial records and identify discrepancies; participate in the resolution of financial discrepancies.

• Stay up to date on changes in insurance regulations and industry best practices for revenue cycle billing management.

• Work with internal and external partners and a Third-Party Administrator (TPA) to ensure accurate record keeping. Attend and participate in a variety of assigned meetings, committees, conferences, in-services and/or special events.

• Comply with schedules, policies, regulations, procedures, orders and directives of the County Superintendent.

• Exhibit professionally appropriate interpersonal skills including but not limited to tact, patience, flexibility and courtesy.

• Maintain a safe work environment.

• Operate a variety of office equipment, including but not limited to a computer and assigned software applications.

• Serve as a liaison between County Superintendent and administrators, personnel, outside organizations or the public concerning assigned area.

• Serve as a technical resource concerning assigned program, function or instructional area.

• Work collaboratively and maintain effective working relationships with others in the course of work in assigned area.

OTHER DUTIES:

• Driving a vehicle to conduct work, using own transportation and/or FCSS vehicle.

• Perform related duties as assigned.

• Travel may be required for training within California.

KNOWLEDGE AND ABILITIES:

KNOWLEDGE OF:

• Auditing principles and techniques.

• Billing codes (e.g., CPT, ICD-10) used for behavioral and mental health services.

• Data control procedures and data entry operations.

• Education Codes that pertain to related work.

• Financial and statistical record-keeping techniques.

• General accounting, budget and business functions of a county office.

• Generally Accepted Accounting Principles (GAAP) related to insurance.

• Health Insurance Portability and Accountability Act (HIPPA), Family Educational Rights and Privacy Act (FERPA) and privacy regulations governing student health information.

• Insurance terminology, concepts and regulations.

• Local, state, and federal laws and regulations pertaining to insurance claims processing and financial reporting.

• Methods, procedures and terminology used in technical accounting and auditing work.

• Modern office practices, procedures and equipment.

• Preparation of comprehensive accounting reports.

• Preparation, review and control of assigned accounts.

• Software tools and software used for insurance claims and auditing.

• Standardized Account Code Structure (SACS).

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• Proper English usage, grammar, spelling, punctuation, and vocabulary in all forms of communication.

• Public Contract Codes.

• State Education Code, local, state, and federal laws, codes, regulations and requirements and county office organization, operations, policies and objectives as related to assigned activities and/or instructional area.

• Theoretical and technical aspects of field of specialty.

ABILITY TO:

• Assemble, organize, and prepare data for records and reports.

• Compare numbers and detect errors efficiently.

• Conduct thorough and accurate audits.

• Interpret and apply complex insurance regulations.

• Maintain accurate financial and statistical records.

• Make mathematic computations with speed and accuracy.

• Meet schedules and timelines.

• Monitor and audit income and expenditures.

• Perform a variety of technical accounting duties in the review, analysis and adjustment of assigned county office accounts.

• Prepare and analyze comprehensive accounting reports.

• Reconcile, balance and audit assigned accounts.

• Review, process and verify a variety of financial information.

• Utilize audit software and data analysis tools.

• Analyze and evaluate situations accurately and adopt an effective course of action.

• Communicate effectively both orally and in writing.

• Drive a vehicle to conduct work.

• Interpret, apply, and explain rules, regulations, policies and procedures.

• Maintain consistent, reasonably regular, punctual attendance consistent with federal, state and local standards.

• Safely and successfully perform essential job functions consistent with federal, state and local standards, including meeting qualitative and/or quantitative productivity standards.

• Work confidentially and with discretion.

• Work independently with minimal direction.

EDUCATION AND EXPERIENCE:

EDUCATION:

• High school diploma, General Education Degree (GED) or State High School Proficiency certificate.

• Associate degree in Accounting or related field preferred.

EXPERIENCE:

• One year experience in general accounting and auditing in health care field.

LICENSURE AND OTHER REQUIREMENTS:

• Valid California driver’s license; when driving for work, maintain automobile liability insurance in accordance with California Insurance Code section 11580.1 or maintain other statutorily authorized financial responsibility.

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• Enrollment in the California Department of Motor Vehicles Government Employer Pull Notice Program may be required at time of hire and throughout employment with the County Superintendent.

WORKING CONDITIONS:

ENVIRONMENT:

• Driving a vehicle to conduct work, using own transportation and/or FCSS vehicle.

• Office and/or school facility environment.

• Regular interruptions.

• Small and large group meetings.

PHYSICAL DEMANDS:

• Bending at the waist, kneeling, or crouching; climb or balance.

• Eyesight corrected or uncorrected sufficient to read a variety of materials including but not limited to fine print.

• Hearing with or without use of hearing aid(s) sufficient to hear any conversation with others; understandable voice and speech patterns.

• Manual dexterity and coordination sufficient to operate office and/or classroom equipment.

• Sitting, standing and/or walking for extended periods of time.

• Use hands to handle and/or feel; reach with hands and arms.

• Must frequently lift, push, pull or carry up to ten (10) pounds and occasionally lift and/or move up to twenty-five (25) pounds.

The physical demands and working conditions described here are representative of those that must be met by an employee to successfully perform the essential functions of this position, subject to reasonable accommodation.

This position description may not be an exhaustive list of all duties, knowledge, or abilities associated with this classification; however, it is intended to accurately reflect the principle job elements. Related duties, knowledge, or abilities to those expressly stated may also be required for successful performance of the position.

APPROVED:

Effective: 11/20/2024

Job Type: Part-time

Pay: $30.86 - $35.72 per hour

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: In person

Salary : $31 - $36