Medical Billing Technician - Technician IV CMHHIP

This position is open to current Colorado residents only.Please note: This recruitment may be used to fill multiple vacancies.Most State of Colorado employees are eligible for a great benefit package! Please see the Supplemental Information section below for details!About the Office of Civil & Forensics Mental Health (OCFMHThe Mental Health Institutes at Fort Logan and Pueblo, under the auspices of the Office of Civil & Forensics Mental Health (OCFMH), partners with patients, families and their communities to provide quality services that assist patients in achieving their mental health and health care goals. In addition, Mental Health Institute at Pueblo is the only Colorado facility with a forensic division that serves adults who are found Not Guilty by Reason of Insanity or found Incompetent to Proceed.About the Position:The Patient Financial Services unit must identify and record the gross revenue for all patient/client services assigned within the District. Currently, the agencies served are the Colorado Mental Health Institute at Pueblo, Colorado Mental Health Institute at Ft Logan.The purpose of the Patient Financial Services-Institutes is to 1) maximize revenue in accordance with the Colorado Revised Statutes and Long Bill requirements, from all sources of income, 2) provide patient banking functions and serve as trustee for patient funds, 3) assure that patients access all eligible benefits in a timely manner, and 4) develop and produce financial reports that accurately assess the status of all revenue requirements for agencies within the southern Accounting District’s area of responsibility. The work groups determine, adjust, bill, and collect net revenue, and calculate patient/client Ability to Pay (ATP). Patients’ Accounts serves as fiduciary and Trustee for Patients’ personal funds. Responsibilities in this position Include:• Prepare and submit claims to third-party payers, which may include Medicare, Medicaid, RAE (Regional Accountable Entities), Courts, Patients, and any other third-party payer benefits a patient may be eligible to receive. Identify and/or develop third party resources for patients including requests for information from Medicare/Social Security Administration, Medicaid, Department of Social Services, Regional Accountable Entities (RAEs), Veterans' Administration and other applicable agencies to verify if patient is receiving or eligible to receive benefits on own, spouse's, or parent's work record.• Review and record information received from patients, family and other sources.• Adjusts individual accounts when new benefit information is received and/or when current benefits change. Adjustments are made in accordance with Colorado Revised Statutes (CRS) in order to reflect correct revenue based on collection of payments, or receipt of additional information.• Review payments from third party payers and patient/family/responsible parties for correctness and coordination of billing. Respond to inquiries and correspondence• from patients, outside agencies, patient's families, and/or others such as attorneys or conservators.• Notify immediate supervisor of any possible problems or issues with accounts.• Our primary customers are the Mental Health Institutes, and we provide services to all people on campus, of all ages and backgrounds, including the mentally ill and developmentally disabled.Additional Duties Include:Patient Benefits and Ability To Pay• This position analyzes and reviews patient admission information for completeness. If necessary, contact the patient’s family, payee, etc. to clarify information received or to request additional information• gathers and reviews data from the Department of Social Services, Social SecurityAdministration, Medicare, Medicaid, RAEs, and other third party payers to determine benefit coverage limits and/or additional billing and reimbursement information• interprets admission financial information to calculate the patient’s ability to pay (ATP) per state statutes and Department policies• Review benefit documents (SVES, WEBPORTAL, CBMS, Medicare on-line, Avatar bank account balances, legal status) and financial questionnaire on an annual basis for all current patients, or when notified of changes that may affect a patient’s ATP or benefits• submit applications and/or contact outside agencies for patient benefits.• document all pertinent billing information into the patient’s billing record• assist patients, families, social workers, etc. in developing possible patient benefitsMedical Billing:• prepares and submits Medicaid, RAE, and other Third-Party institutional claims via electronic billing and/or through the medical claim clearinghouse within timely filing requirements. If electronic claims are not accepted by the clearinghouse, this position may prepare and submit manual claims to the payer• prepares and submits patient pay statements based on the patient’s ability to pay• Prior to submitting claims, this position reviews them for accuracy, including but not limited to, coding, number of days billed, leaves of absence, occurrence and condition codes• monitors and verifies that charges are recording correctly in the billing system based on the number of billable days• regularly interacts with other agencies, such as Center for Medicare and Medicaid Services (CMS), Colorado Medicaid (HCPF), Social Security(SSA), County Social Services, and others concerning a patient’s benefit eligibility• keep up-to-date on Medicaid, Medicare, RAE, and other Third-Party payer billing rulesand regulationsClaim Payments/Denials:• reviews Remittance Advice (RA) and Explanation of Benefit (EOB) forms to verify payment equals billed charges less any contractual allowances, co-insurance, and/or deductible amounts• reviews payments posted in the billing system to ensure they were posted correctly by the Banking Department• after payment is received, this position reviews a patient’s file for current ability to pay information and Medicaid web portal, for Medicaid eligibility, to determine the appropriate adjustments to make for the coinsurance and deductible amounts• documents payment and adjustment details to a patient’s account in the patient’s billing notes• researches any payment variances, and contacts the specific payer to resolve anypayment/denial issues. If this position is unable to resolve issues with a payer, the supervisor is notified so they can attempt to resolve the problemPayables:• review and reconcile accounts with credit balances to verify the account is correct and that a refund is due• review invoices payable by Patient Financial Services and gather necessary backup for payment processing• create a receiving report for the OCFMH CFO signature approval for payment. Thereceiving report will be coded to the appropriate CORE accounting coding string according to patient unit location• create an invoice packet for General Accounting for data entry into CORE for payment. The invoice packet will include the spreadsheet with detailed payment information, including name, patient location, de-identifier number, Core coding, and amount to pay. The packet will also include a signed receiving report by the OCFMH CFOBilling Notes, Filing, Other Duties As Assigned:• documents all relevant information into the patient billing notes (Yellow Card), including, but not limited to, admission information, payments, denials, ATP calculations and determinations, contacts with patients, families, payees, social workers, third-party payers, etc. The billing notes (Yellow Card) is a criticaldocument that contains relevant information on the account used by staff and management for multiple purpose• maintains an organized file on each patient• files documents into a patient’s file in a timely manner so that other staff and management can quickly and easily find information needed.• this position may assist, as needed, with projects or duties as requested by SupervisorMINIMUM QUALIFICATIONSFour (4) years of experience in medical billingORA combination of related education and relevant experience in an occupation related to the work assigned equal to four (4) yearsPreferred Qualifications:• Familiar with Medicare and Medicaid rules and regulations; Medical billing experience• Familiar with SVES, CBMS, Medicare On-Line, Webportal; BEHR; CORE CodingProficient with Microsoft Excel and Word• Customer service experience• Ability to adapt to change• Basic math skills• Excellent interpersonal skills• Ability to work independently or as part of a team• Organizational skills• Basic filing skills• Familiarity with basic office duties, e-mail, and using a copier, fax, and scanner.• Relevant working experience within the Office of Behavioral Health – CFO Office• Previous State ExperienceConditions of Employment:• Occasional travel necessary to attend training, using state fleet vehicle service.• A pre-employment criminal background check will be conducted as part of the selection process as this position is deemed to have direct contact with vulnerable persons. Felony convictions, conviction of crimes of moral turpitude, or convictions of misdemeanors related to job duties may disqualify you from being considered for this position. Should your background check reveal any charges or convictions, it is your responsibility to provide the CDHS Background Unit with an official disposition of any charges. Additionally, you will be required take and pass a drug screen.• TB Test must be completed• Former State employees who were disciplinarily terminated or resigned in lieu of termination must (1) disclose that information on the application (2) provide an explanation why the prior termination or resignation should not disqualify the applicant from the current position, (3) provide the employee number from the applicant’s prior State employment. Absent extraordinary circumstances, prior disciplinary termination or resignation in lieu of termination and failure to provide this information will disqualify the applicant from future State employment with CDHS.• On or after October 31, 2021, each facility shall ensure all newly hired employees or support staff members are fully vaccinated at the time of hire or receive their first dose of a two-dose protocol, or a single-dose vaccination, prior to providing any care, treatment, or other services for the facility and/or its clients. Upon hire, new employees will have three (3) business days to provide attestation to their status with proof of vaccination. Vaccinated employees must provide proof of first dose prior to providing care. Note: Fully Vaccinated means two (2) weeks after a second dose in a two-dose series of the COVID-19 vaccine, such as the Pfizer, Moderna or Novavax vaccine, or two (2) weeks after the single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine. Religious and medical exemptions and reasonable accommodation shall be addressed as required by law pursuant to the Equal Employment Opportunity Commission’s vaccination guidance. If you would like to request a medical or religious exemption, please contact CDHS_HumanResources@state.co.usAppeal Rights:If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director.An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email (dpa_state.personnelboard@state.co.us), postmarked in US Mail or hand delivered (1525 Sherman Street, 4th Floor, Denver CO 80203), or faxed (303.866.5038) within ten (10) calendar days from your receipt of notice or acknowledgement of the department’s action.For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board; go to spb.colorado.gov; contact the State Personnel Board for assistance at (303) 866-3300; or refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov under Rules.How to ApplyThe Assessment ProcessFor additional recruiting questions, please contact jazzma.gamboa@state.co.usAbout Us:If your goal is to build a career that makes a difference, consider joining the dedicated people of the Colorado Department of Human Services (CDHS). Our professionals strive to design and deliver high quality human and health services that improve the safety, independence, and well-being of the people of Colorado. In addition to a great location and rewarding and meaningful work, we offer:• Strong, secure, yet flexible retirement benefits including a PERA Defined Benefit Plan or PERA Defined Contribution Plan www.copera.org plus 401(k) and 457 plans• Medical and dental health plans• Employer supplemented Health Savings Account• Paid life insurance• Short- and long-term disability coverage• 11 paid holidays per year plus vacation and sick leave• BenefitHub state employee discount program• Employee Wellness program MotivateMe• Excellent work-life programs, such as flexible schedules, training and more• Remote work arrangements for eligible positions• Some positions may qualify for the Public Service Loan Forgiveness Program. For moreinformation, go to https://www.colorado.gov/pacific/dhr/student-loan-forgiveness-programs.Our Values:We believe in a people-first approach: To serve the people of Colorado, we develop a culture and work environment that creates an energized, inspired, and healthy team capable of giving their best to Coloradans.Balance creates quality of life: We want our team to be resilient through a supportive workplace that values flexibility, health and wellness, and employee engagement.We hold ourselves accountable: We take responsibility through our actions, programs, and results for the state of health and human services in Colorado.Transparency matters: We are open and honest with employees, our partners, the Coloradans we serve, and the public.We are ethical: We abide by what is best for those we serve by doing what is right, not what is easy.Collaboration helps us rise together: We work together with all partners, employees, and clients to achieve the best outcomes for Coloradans.We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.ADAA Accommodations: CDHS is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAA Coordinator, Nancy Schmelzer, at cdhs_ada@state.co.us or call 1-800-929-0791.~THE STATE OF COLORADO IS AN EQUAL OPPORTUNITY EMPLOYER~