Medical Billing Specialist 2
Category: Classified
Pay Grade: C18
Job Code: 10796
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 technical and financial 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); Coordination with the County Attorney’s Office in ensuring the collection of funds owed and resolution of estates, probates, auto, claims etc.; In-depth knowledge and independent application of State and Federal regulations governing healthcare: Knowledge of standard medical terms; A high degree of independent judgment in applying concepts such as medical necessity; Applied knowledge of billing nuances related to private and public insurance carriers, hospitals, hospices, Veterans Administration, and skilled nursing facilities; Account analysis to determine the appropriate next steps in the disposal of accounts; Determining the appropriate billable party; Interpretation application of complex regulations and Department procedural billing policies; and determining and resolving various facets of secondary billing functions, e.g., denials, filing appeals, payment errors, no payer responses, etc. This is the journey level in the class series. Positions may provide direction and instruction to lower-level medical billing staff and may act as a group lead for one or more support staff. The position reports to a supervisor or manager. This position differs from the Medical Billing Specialist 1, in it requires a higher level of independent judgment and decision- making. The nature of assignments are at the higher end of the complexity scale.
ESSENTIAL JOB FUNCTIONS (examples, not all inclusive)
- Researches, verifies, updates, and assures the accuracy of information in the medical billing system and the Sunstar Membership Program;
- Preform Quality Assurance (QA) reviews or pre-and post-billed ambulance, discerning any favorable or unfavorable billing patterns or trends;
- Technical processing of medical ambulance claims, including determining the appropriate level of service;
- Payment posting associated with complex payers such as Medicare and Medicaid;
- Determine the appropriate payer based on the circumstance of the transport and applicable State and Federal laws;
- Assists in training employees on insurance verification and billing procedures;
- Provide technical assistance to the public related to the nuances of how their claims were adjudicated by the related payer;
- Monitor assigned hospital and skilled nursing facility accounts for timely payment, payment trends, and resolution of billing issues;
- Interprets medical information provided on ambulance Patient Care Reports, Physician Certification Statements, hospital records to determine medical necessity, level of service, and assignment of the appropriate International Classification of Disease (ICD) coding;
- Audit and review of accounts to validate the appropriates of pass actions and to determine next steps;
- Conduct investigations and audits to resolve problems associated with misapplied funds or dormant accounts;
- Handle resolution of billing issues with patients and insurance carriers;
- Assist and fill in for supervisory level position in scheduling, assigning, and prioritizing duties for employees to ensure workload is accomplished;
- Performs a variety of tasks related to an automated office environment;
- Processes credit card payments via phone;
- Processes check payments received via mail or walk -in customers with cash or check, and issue receipts as necessary;
- Prepare status reports and performs special projects as required;
- Performs other related job duties as assigned.
QUALIFICATIONS
Education and Experience:
Five (5) 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.
- 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 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;
- Skill in the application of quality customer service;
- Skill in the operation of automated office equipment;
- Ability to apply basic computer applications and billing software;
- 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 understand and follow oral and written instructions and to express oneself clearly and concisely, orally and in writing, and to communicate effectively with internal and external departments, customers, and agencies on often controversial issues;
- Ability to type with reasonable 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:
- 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 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.
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.