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 medical or dental claims.

Knowledge of working medical or dental claims for appeals and denials.

.

Florida Department of Health Mission, Vision, and Values:

Mission:

To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts.

Vision:

To be the Healthiest State in the Nation.

Values:

I nnovation: We search for creative solutions and manage resources wisely.

C ollaboration: We use teamwork to achieve common goals & solve problems.

A ccountability: We perform with integrity & respect.

R esponsiveness: We achieve our mission by serving our customers & engaging our partners.

E xcellence: We promote quality outcomes through learning & continuous performance improvement.

Where You Will Work:

Work Location: Dr. Carter Blvd. Bunnell, FL 32110

The Benefits of Working for the State of Florida:

Working for the State of Florida is more than a paycheck. As an OPS employee, the benefits below are available:

• State of Florida 401(a) FICA Alternative Plan (mandatory)
• Participation in state group insurance (upon meeting eligibility requirements.  Consult with People First and/or the serving HR office)
• Workers’ Compensation (mandatory, if needed)
• Reemployment Assistance (Unemployment Compensation) (mandatory, if needed)
• Deferred Compensation (voluntary)
• Employee Assistance Program (voluntary)
• And more!

For a more complete list of benefits, including monthly costs, visit www.mybenefits.myflorida.com.

Please be advised:

Your responses to qualifying questions for this position must be verifiable by documentation provided through the electronic application process.  

This position requires a security background check and/or drug screening and participation in direct deposit. Any misrepresentations or omissions will disqualify you from employment consideration. Note: You will be required to provide your Social Security Number (SSN) in order to conduct this background check Successful completion of a drug test is a condition of employment for safety-sensitive positions.

Male applicants born on or after October 1, 1962, will not be eligible for hire or promotion unless they are registered with the Selective Services System (SSS) before their 26th birthday, or have a Letter of Registration Exemption from the SSS. For more information, please visit the SSS website: http://www.sss.gov 

If you are a retiree of the Florida Retirement System (FRS), please check with the FRS on how your current benefits will be affected if you are re-employed with the State of Florida.  Your current retirement benefits may be canceled, suspended or deemed ineligible depending upon the date of your retirement. 

The successful candidate will be required to complete the Form I-9 and that information will be verified using the E-Verify system.  E-Verify is operated by the Department of Homeland Security in partnership with the Social Security Administration to verify employment eligibility.   

Incumbents may be required to perform emergency duty before, during, and/or beyond normal work hours or days.

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer and does not tolerate discrimination or violence in the workplace. 

Applicants requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-877-562-7287). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation. 

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act. 

Florida has the third largest population of veterans in the nation with more than 1.5 million service men and women.  The Florida Department of Health (department) is committed to serving members of the United States Armed Forces, veterans and their families by encouraging them to apply for vacancies that fit their area of knowledge and/or expertise.  Through the Department's VALOR program, which expedites licensing for military veterans, the Department also waives initial licensing and application fees for military veterans who apply for a health care professional license within 60 months of an honorable discharge. These initiatives help ensure that the transition from military service into the workforce is as smooth as possible and reflects our appreciation for the dedication devoted to protecting our country.    

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.