Management Analyst 1 - Medical Billing - Health and Human Services

Join our team as a Medical Billing Analyst (Management Analyst 1) and make a meaningful impact in the healthcare industry! We’re seeking a detail-oriented professional with expertise in medical health plan contracting and compliance auditing to help us drive excellence in billing operations and regulatory adherence. In this pivotal role, you’ll have the opportunity to analyze complex data, ensure accuracy in claims, and contribute to seamless payer-provider relationships—all while playing a key role in upholding the integrity of our healthcare services. If you’re passionate about making a difference and thrive in a fast-paced, collaborative environment, we want to hear from you!"

GENERAL STATEMENT OF DUTIES
Perform a variety of professional management tasks that have department-wide scope and impact, including program development, preparing and analyzing project budgets, and analyzing contractual and administrative operations.
 
SUPERVISION RECEIVED
Work under the supervision of a department head or designee.
 
SUPERVISION EXERCISED
May provide leadership and direction to assigned support staff in relation to special projects or assignments.

Provide Management Analysis and Support to the Health Department Billing Team

•  Assist the Sr. Administrative Manager in contracting with health plans to attain panel membership.  

• Requires understanding of health plan contracting methodologies, including conversion factors and RVUs as it relates to reimbursement for the Health Department.  

• Prepare, negotiate, administer, and monitor contractual services agreements, while serving as a liaison with health plan providers.  

• Act as an organization site administrator for health plan websites.  

• Provide supporting data to analyze the impact of contract proposals and proposed reimbursement rates on organization.

• Develop and maintain strong relationships with health plans.  

• Communicate and follow up with internal staff, county departments and health plans regarding the status of contract negotiations and potential impact on operations. 

• Provide leadership and direction for the Health & Human Services Billing Team comprised of medical billing specialists/coders and OS 2 on special projects or assignments.

• Assist the Sr. Admin Manager in analyzing and resolving complex denied claims or billing issues.  

• Provides assistance in understanding and interpreting payor guidelines and policies.  

• Support and review denial reports, outstanding claims and provide support work on appeals with health plans.  

• Review accounts receivable aging reports and make recommendations for write offs.  

• Schedule routine audit for payment reimbursement accuracy according to health plan contracts through data analysis.  

• Review reports for optimum billing efficiencies and maximum reimbursement by studying utilization of procedure codes for service areas; analyzing trends, etc. and provide reports to Health Department management.  

• Monitor charges and verify correct payment of claims, generate and review payment reports for accuracy and compliance as needed.

• Assist and support as facilitator along with the billing lead for billing program audit and compliance committee- responsible for overseeing and conducting audits of medical billing and coding processes to ensure compliance with regulatory standards, payer requirements, and organizational policies. This involves identifying billing discrepancies, ensuring accurate coding, training staff on proper billing practices, and facilitating corrective action plans to improve accuracy and compliance. 

• Assist and support billing lead with new program billing requirements and set up along with program area contacts for services.  

• Support and/or facilitate program billing meetings as needed on education/training for compliance purposes in relation but not limited to audit requirements and new billing/coding guidelines.

• Serve as a resource for staff and management on billing related issues and assist with Billing Team customer service efforts.

• Assist and support in creating, drafting, and annually updating billing processes and procedures manual

• Support coders in creating and annually updating coding manual based by program billing criteria and nuances

• Participate in Billing Team meetings.  Take minutes and assist with the development of the team agenda.   Facilitate as needed.  

• Attend monthly Administrative Services Division and contract team meetings.  Schedule meetings as needed in support of the Sr. Administrative Services Manager.

Billing Team Backup Support

• Be able to provide backup support to the Medical Billing Specialists where applicable.  Assist with all essential and time sensitive tasks in order ensure coverage for team members.  

• Other duties as assigned by your supervisor. 

Response Level 1: In the event of an emergency, employee makes a reasonable effort to report to work. Employee may be required to perform duties outside of their regularly assigned duties. Employee may be requested to work an extended or flexible schedule. Due to regular assignment, employee may be assigned a leadership role in the provision of essential services or response functions. Staff at this response level must complete Incident Command System 100, 700, 200, and 800 online or in-person training.

EXPERIENCE AND TRAINING

1. Bachelor's degree in public or business administration, accounting or a related field; AND
2. Two years of responsible experience which includes independent research, design and methodology, and management analysis; OR
3. Any satisfactory combination of work, education, training, or experience relevant to the position, as determined by Marion County.

NECESSARY SPECIAL REQUIREMENTS

• The finalist for this position will be required to pass a criminal history background check; however, conviction of a crime may not necessarily disqualify an individual for this position.
• This position may be subject to the following:  Must not be excluded from participation in the federal health care programs (Medicaid, Medicare and other federally funded programs that provide health benefits); AND must not be excluded from participating in federal procurement (Federal Acquisition Regulation) and non-procurement activities (Executive Order No. 12549).
• This assignment is represented by a union.
• This is a full-time position, which is eligible for overtime.
• Typical Schedule:  Monday - Friday, 8:00 am - 5:00 pm, with flexibility depending upon the needs of the department.

ADDITIONAL REQUIREMENTS 
Specific recruitments may require experience, or specialized education, certifications, training, or licensures with time-sensitive expectations.  This position requires the ability and experience with negotiating and understanding health plan contracts and its relation to medical billing practice. This position will also need experience with reimbursement methodologies. 

KNOWLEDGE, SKILLS, AND ABILITIES
Knowledge of the principles and practices of public administration and of the principles of sound organization and management; financial principles and practices in local government, and of budget preparation and administration techniques; organizational processes and design; the principles and practices of statistical analysis and data collection.

Ability to research and analyze issues and procedures; write clear and concise reports; ability to prepare a budget and to evaluate budgetary requests; conduct and evaluate surveys and special studies; prepare recommendations and to communicate effectively in both oral and written form; prepare and deliver oral presentations; establish and maintain positive working relationships with coworkers and the public; lead, direct, and participate in training and evaluating personnel.

PHYSICAL REQUIREMENTS
Stands; sits; moves about the work area; climbs 1 floor of stairs; reaches overhead; lifts up to 10 lbs.; pushes, pulls, moves carts and carries up to 5 lbs.; operates a computer and keyboard; speaks clearly and audibly; reads a 12 pt. font; hears a normal level of speech; may rarely be exposed to heat, cold, dust, office chemicals, vibration, humidity, noise, uneven and wet areas; may rarely traverse ladders and scaffolding.  

Salary : $30 - $40