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Medical Billing Specialist 1

Category: Classified
Pay Grade: C16    
Job Code: 10797

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

Performs complex work specializing in the compliance, oversight, analysis, and processing of functions associated with 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); Applied knowledge of State and Federal regulations governing healthcare; Familiarity with standard medical terms; A high degree of independent judgment in applying concepts such as medical necessity; Monitoring payment data associated with public and private insurance carriers,  hospitals,  and skilled nursing facilities; Facilitating actions geared toward the collection of accounts; Determining the appropriate billable party; and Working various facets of secondary billing functions, e.g., denials, payment errors, no payer responses, etc. This position differs from the Medical Billing Specialist 2 in that the level of independent interpretation of application of healthcare regulations and actions is lower, and the applicable assignments are less complex. Incumbents refers difficult analysis, technical policy or procedural questions to a more senior staff for resolution.

ESSENTIAL JOB FUNCTIONS (examples, not all inclusive)

• Provides technical information, assistance, and services to ambulance billing vendor, the general public, employees, and others professional partners in person, through computer business applications, by telephone, or by other forms of communication;
• Delivers support and assistance to others as well as higher level staff in performance of a wide range of countywide missions, functions, and activities;
• Operates billing software to provide information, resolve routine problems or complaints completing tasks that may include data entry, data retrieval, data analysis, and coordination with other units;
• Apply applicable State and Federal rules and regulations governing healthcare providers to determine the appropriate disposal of an account;
• Research, compile, sort, tabulate, and summarizes data associated with a specific entity or payer to oversee a specific account;
• Align work processes for compliance with applicable healthcare regulations and Department billing policies;
• Plan and confirm required information associated with billing an individual, payer, or facility;
• Utilize various websites and portals to determine insurance coverage, patient status, demographics, etc.;
• Prepares appeals for denied claims to public and private insurances articulating the basis for the appeal;
• May operate office equipment, transcription equipment, printers, copiers, and other assignment specific equipment;
• Interpret ambulance transport Patient Care Reports (PCR), Physician Certification Statements (PCS), and hospital records to determine medical necessity and appropriate level of billing by analysis of the interventions performed and documented condition of the patient;
• Handle correspondences, including executing the return mail process; extracting insurance information from related documents, and segregation of various billing related mail items to ensure documents are scanned into the proper electronic file location;
• Post routine account payments such as patient pays and commercial insurance;
• Resolve routine issues associated with claims rejections that occur during electronic claim submission;
• May relieve or fill in for other employees;
• Performs other related job duties as assigned.

QUALIFICATIONS

Education and Experience:

Three (3) years’ experience in medical billing, claim analysis, denial review, or secondary billing workflow functions 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.
• May be required to keyboard up to 35 wpm depending on area of assignment.
• Depending on area of assignment, employee’s name must not appear on the Health & Human Services exclusion list.
• Other knowledge, skills, abilities, and credentials required for a specific position.

Knowledge, Skills and Abilities:

• Knowledge of business English, spelling, and punctuation;
• Knowledge of standard office practices, procedures, and equipment;
• Knowledge of standard medical terms;
• Knowledge of State and Federal regulations that govern healthcare providers;
• Knowledge of HIPAA’s privacy and security requirements as they pertain to protected health care information;
• Ability to apply critical thinking skills in the assessment of claims, accounts, and payments;
• Ability to serve as unit leader and guide others in completion of assignments;
• Ability to receive the public and professional partners with tact, patience, and courtesy;
• Ability to apply applicable guidance in the billing claims at the appropriate level;
• Ability to apply computer applications and billing software necessary to bill and monitor claims data;
• Ability to interpret and apply rules, regulation, and written billing guidance;
• Ability to compose and prepare routine communications;
• Ability to type with reasonable speed and accuracy;
• Ability to make arithmetical computations with speed and accuracy;
• Ability to sit, stand, lift, and perform physical labor to complete location specific assignments.

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 to lift, carry, push, pull, or otherwise move objects, including the human body. Additionally, the following physical abilities are required:

• Feeling: Perceiving attributes of objects, such as size, shape, temperature or texture by touching with skin, particularly that of fingertips.
• Fingering: Picking, pinching, typing, or otherwise working, primarily with fingers rather than with the whole hand as in handling.
• Grasping: Applying pressure to an object with the fingers and palm.
• Handling: Picking, holding, or otherwise working, primarily with the whole hand.
• Kneeling: Bending legs at knee to come to a rest on knee or knees.
• Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position-to-position. Occurs to a considerable degree and requires substantial use of upper extremities and back muscles.
• Pulling: Using upper extremities to exert force in order to draw, haul or tug objects in a sustained motion.
• Pushing: Using upper extremities to press against something with steady force in order to thrust forward, downward or outward.
• Reaching: Extending hand(s) and arm(s) in any direction.
• 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 recording 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.
• Standing: Particularly for sustained periods of time.
• Stooping: Bending body downward and forward by bending spine at the waist. Occurs to a considerable degree and requires full motion of the lower extremities and back muscles.
• Walking: Moving about on foot to accomplish tasks, particularly for long distances or moving from one work site to another.

WORKING CONDITIONS

Work is performed in a dynamic environment that requires me to be sensitive to change and responsive to changing goals, priorities, and needs.