Medical Billing Specialist III/IV – Behavioral Health

Medical Billing Specialist III/IV

Under general direction (III, IV), performs and is responsible for billing and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, Medicare, and general insurance reimbursement requirements. The ideal candidate has specialized expertise in mental health billing, including CPT, ICD-10, and HCPCS coding for Medicare and Medi-Cal. Skilled in the Medi-Cal Provider Manual and TAR process, they ensure timely, compliant submissions that support access to behavioral health services. They communicate effectively with peers, patients, and payers, resolve billing discrepancies, and address compliance issues in collaboration with the compliance office. Experienced in leading and training staff on Managed Care, Medicaid, Medi-Cal, Medicare, and Commercial Insurance, they ensure accuracy, efficiency, and regulatory adherence in all mental health billing operations.

Medical Billing Specialist III ($25.99 - $32.99 per hour) is the advanced-journey level class performing more complex work involving extensive analysis and research through the use of multiple electronic health record (EHR) systems such as Cerner, HURON, and/or Claim Source to follow up on accounts.

Medical Billing Specialist IV ($28.84 - $36.62 per hour) is the lead level class and serves as technical advisors to lower-level Medical Billing Specialists. In addition to performing advanced-journey billing work, incumbents perform program administrative duties to assure that all claims are billed timely.

The County of Ventura offers an attractive compensation and benefits package that includes:

• Merit Increases
• Educational Incentive
• Bilingual Incentive
• Vacation Accrual
• Vacation Leave Redemption
• Sick Leave
• Deferred Compensation
• Health Plans
• Flexible Spending Accounts
• Pension Plan
• Holidays
• Additional Benefits

AGENCY/DEPARTMENT: Health Care Agency - Ventura County Behavioral Health (VCBH)

Medical Billing Specialist III/IV are represented by the Service Employees' International Union (SEIU) and are eligible for overtime compensation. The eligible list established from this recruitment may be used to fill current and future Regular (including Temporary and Fixed-Term), Intermittent, and Extra-Help vacancies. There are currently three (3) Regular vacancies in Ventura County Behavioral Health NOTE: If appointed at the lower level, incumbent may be promoted to the higher level without further exam upon meeting the minimum requirements, demonstrating satisfactory performance, and in accordance with the business needs of the department.

TENTATIVE SCHEDULE OPENING DATE: 8/27/25 CLOSING DATE: Continuous and may close at any time; therefore, the schedule for the remainder of the process will depend upon when we receive enough qualified applications to meet business needs. It is to your advantage to apply as soon as possible.

Examples Of Duties

Duties may include but are not limited to the following:

• Reviews and analyzes bills as they come off the system and bills/transmits them in a timely manner to the appropriate intermediary;
• Ensures accuracy and compliance with billing, coding, and follow-up requirements and identifies overpayments and lack of documentation issues;
• Maintains work queue with backlog to 46 hours of receipt only;
• Reviews and follows up on denial codes transmitted to providers for potential reimbursement on claims;
• Provides information to payors and ensures that reimbursement is received.
• Gathers, compiles, and analyzes billing and statistical analysis;
• Prepares bills and claims and transmits them on a timely basis;
• Provides advanced-level billing and supervision as a lead person to the respective Medicare and/or Medi-Cal Departments;
• Reviews submittals to ensure accurate transmission and timely payment;
• Reviews bulletins to identify new programs that may affect reimbursement for Medi-Cal and/or Medicare and prepares reports;
• Serves as lead biller/specialist to the department; and
• Performs other related duties as required.

Medical Billing Specialist IV: In addition to Medical Billing Specialist III level duties, Medical Billing Specialist IV may also include:

• Advises and consults with management on how to reduce the days in accounts receivable regarding Medicare, Medi-Cal, or other insurance;
• Develops effective trainings for staff in registration and billing and supervises or conducts training on the specific areas of Managed Care/Medicaid/Medi-Cal/Medicare and/or Commercial Insurance;
• Works with the billers and management to identify areas where reimbursement delays may be decreased; and
• Coordinates integration of workflow.

Typical Qualifications

These are entrance requirements to the examination process and assure neither continuance in the process nor placement on an eligible list. EDUCATION, TRAINING, AND EXPERIENCE Any combination of education and experience which has led to the acquisition of the required knowledge, skills, and abilities. The required knowledge, skills, and abilities can typically be obtained by hands-on working knowledge and experience in a medical complex comparable to Ventura County Behavioral Health and affiliated clinics.

Medical Billing Specialist III - Three (3) years of professional billing experience including preparation of financial statements OR two (2) years as a Medical Billing Specialist II for the County of Ventura.

Medical Billing Specialist IV - Four (4) years of professional billing experience OR one (1) year as a Medical Billing Specialist III for the County of Ventura. Desired:

• An Associate's or Bachelor's degree in a business-related field
• Medical billing experience within a behavioral health organization
• Basic proficiency using MS Excel
• Experience in Managed Care and Commercial Insurance billing
• Experience with multiple electronic health record (EHR) systems, such as Cerner, HURON, and/or Claim Source to follow up on accounts
• Supervisory experience

KNOWLEDGE, SKILLS AND ABILITIES Knowledge of:

• Medical reimbursement programs and complexity of payment systems.
• Current Procedural Terminology Codes (CPT) codes, International Classification for Diseases (ICD)-10 codes, Health Care Procedure Coding System (HCPCS) codes for payment processing of Medicare and/or Medi-Cal.
• Medi-Cal Provider Manual for Billing and Policy and Program and Eligibility.
• Treatment Authorization Request (TAR) process.

Ability to:

• Demonstrate open and direct communication with peers, managers, patients, and payers.
• Process bills accurately and receive prompt reimbursements.
• Research accounts for overcharges, appropriate billing information, and appropriate payment methodology.
• Evaluate and identify compliance and audit issues and work progressively with the compliance office to identify and resolve regulatory conflicts.
• At the MBS IV level, lead billers and conduct training on the specific areas of Managed Care/Medicaid/Medi-Cal/Medicare and/or Commercial Insurance.

Recruitment Process

FINAL FILING DATE: This is a continuous recruitment and may close at any time; therefore, apply as soon as possible if you are interested. Your application must be received by County of Ventura Human Resources in Ventura, California, no later than 5:00 p.m. on the closing date. To apply on-line, please refer to our website at www.venturacounty.gov/jobs . If you prefer to fill out a paper application form, please call (805) 677-5184 for application materials and submit them to County of Ventura Human Resources- Health Care Agency, 646 County Square Drive, Ventura, CA 93003. Note to Applicants: It is essential that you complete all sections of your application and supplemental questionnaire thoroughly and accurately to demonstrate your qualifications. A resume may be attached to supplement your responses in the above referenced sections; however, it may not be substituted in lieu of the application.

LATERAL TRANSFER OPTION: If presently permanently employed in another "merit" or "civil service" public agency/entity in the same or substantively similar position as is advertised, and if appointed to that position by successful performance in a "merit" or "civil service" style examination, then appointment by "Lateral Transfer" may be possible. If interested, please click here (Download PDF reader) for