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Ambulance Billing Analyst

Category: Classified 
Pay Grade: C20  
Job Code: 10857 

To perform this job successfully, an individual must be able to perform the essential job functions satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the primary job functions herein described. Since every duty associated with this position may not be described herein, employees may be required to perform duties not specifically spelled out in the job description, but which may be reasonably considered to be incidental in the performing of their duties just as though they were actually written out in this job description.  

JOB SUMMARY 

This is highly complex medical billing, accounting, financial and analytical work performing a variety of specialized duties related to an ambulance billing revenue cycle. Competences and functions include: Execution of the Emergency Medical Services (EMS) medical billing system with emphasis on ensuring funds due to the County are received from public and private insurance companies, including The Center for Medicare and Medicaid Services (CMS); Oversee the duties and functions of subordinate staff; Expertise in the protocols of private and public insurance carriers and the regulations that govern them; Conducting individual or comprehensive fiscal payers analysis; Drafting business processes and procedures; Audit of accounts to ensure alignment with rules, regulations, or term and conditions associated with designated funding or programs; Processes accounting and financial transactions that require a high level of independent judgment in researching and reconciling discrepancies; Interpret and apply Federal and State rules, regulations, statutes, and guidance; Process related legal duties coordinating with the County Attorney’s Office; Retrieve data and prepare reports, financial statements, analysis, and fiscal or programmatic summaries; and special projects as assigned.  The position reports to a manager or supervisor.

ESSENTIAL JOB FUNCTIONS (examples, not all inclusive) 

• Supervise, train., and provide technical support to subordinate staff;
• Prepares fiscal and programmatic reports related to specific insurance carriers, reconciliation of accounts, outstanding balances, payment trends, etc.;
• Provide technical support to subordinate staff, supervisors, and managers;
• Conduct Quality Assurance (QA) audit of Department functions, compliance with related regulations, and terms and condition of specified funding or programs;
• Resolution of complex billing errors, misapplied funds, and other business-related anomalies, inclusive of conducting applicable research; 
• Execute legal processes related to bankruptcies, subpoenas, filing/releasing claims against estates, release of record, etc.;
•  Answers questions that involve searching for, and abstracting and manipulating technical data from sources;
• Applying County, Department and Division policies, procedures, and guidance in the commission of duties;
• Write fiscal/billing processes and procedures that align with Division workflows;
• Analyze and verify daily edit reports, including identifying and addressing any noted anomalies;  
• Research unidentified funds to determine which accounts they should be attributed to;
• Serves as back-up to co-workers and may serve as back-up for higher-level employees;
• Perform a variety of functions associated with the later activities of the revenue cycle, such as claim appeals, inaccurate claim denials, payment errors, determining entity to whom a refund is due in overpayments, etc. 
• Examine, reconcile, and properly apply claim remittances, Explanation of Benefits, bank statements invoices, etc.;
• Prepare, audit, or compile, computer-generated spreadsheets, revenue tracking report, daily deposit reconciliations, revenue distribution reports, etc.;
• Assist with billing and payment posting as needed;
• Performs other related job duties as assigned.

QUALIFICATIONS 

Education and Experience: 

Six (6) years of experience in accounting, working in a medical billing environment, conducting data analysis, reconciling accounts, resolution of complex billing issue and practical use of computer equipment; or an associate degree (or two (2) years of other related college level education) in accounting, business administration, or related field; or an equivalent combination of education, training, and/or experience.

Special Qualifications (May be required depending on area of assignment): 

• Florida Driver’s License or Florida Commercial Driver’s License and endorsement, if any.
• Assignment to work a variety of work schedules including compulsory work periods in special, emergency, and/or disaster situations.
• Other knowledge, skills, abilities, and credentials required for a specific position.

Knowledge, Skills and Abilities:  

• Knowledge of the principles of government accounting and record keeping procedures pertinent to the area of assignment;
• Knowledge of Federal and State regulations that govern healthcare;

• Knowledge of medical terminology, grammar, spelling, math, and bookkeeping methods;
• Ability to make and apply decisions in accordance with laws, regulations, and procedures;
• Ability to interpret and apply rules, regulations, and written billing guidance;
• Ability to analyze accounts, perform computations, determine amounts due, and responsible parties;
• Prepared correspondences and other forms of written dialog with professional partners;
• Ability to articulate complex billing issues both in writing and verbally;
• Ability to apply accounting and billing practices, procedures, regulations, and source documents;
•  Knowledge of medical terminology;
• Knowledge of basic mathematical/fiscal computer applications;
• Knowledge of governmental accounting practices;
• Knowledge of governmental budgetary procedures, financial accounting, and fund organization;
• Knowledge of modern office practices, procedures, and equipment;
• Knowledge of personal computer applications, procedures, and equipment;
• Ability to analyze data and draw logical conclusions;
• Ability to review and evaluate the work of associates;
• Ability to analyze account transactions and make appropriate correcting entries;
• Ability to establish and maintain effective working relationships with others;
• Ability to make arithmetical computations quickly and accurately;
• Ability to operate standard office equipment;
• Ability to follow written and oral instructions;
• Ability to perform a wide variety of difficult and responsible billing, financial, and analytical functions.

PHYSICAL/MENTAL DEMANDS 

The work is sedentary work which requires exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly.  Additionally, the following physical abilities are required:  

• Fingering: Picking, pinching, typing, or otherwise working, primarily with fingers rather than with the whole hand as in handling.
• Visual ability: Sufficient to effectively operate office equipment including copier, computer, etc.; and to read and write reports, correspondence, instructions, etc.

• Hearing ability: Sufficient to hold a conversation with other individuals both in person and over a telephone; and to hear recordings on transcription device.
• Speaking ability: Sufficient to communicate effectively with other individuals in person and over a telephone.
• Mental acuity: Ability to make rational decisions through sound logic and deductive processes.
• Talking: Expressing or exchanging ideas by means of the spoken word including those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
• Repetitive motion: Substantial movements (motions) of the wrist, hands, and/or fingers.

WORKING CONDITIONS 

Work is performed in a dynamic environment that requires sensitivity to change and responsiveness to changing goals, priorities, and needs.