Medical Billing Supervisor
Category: Classified
Pay Grade: C22
Job Code: 10795
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, analytical, and financial work specializing in supervising a variety of functions associated with the execution of 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); Monitoring the quantity and accuracy of activities performed by subordinate staff; Development of work plans; Developing and maintaining performance standard associated with various functions; Appropriately apply Pinellas County Human Resource Rules and Departmental policies and procedures; Resolving elevated complaints from the public and professional partners; Coordination with the County Attorney’s Office as necessary to resolve legal related billing issues; Expert 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; Staff training and assisting staff to resolve complex billing issues: Perform deep-dive audits of specific accounts, payers, or the work performed by an individual; Drafting processes and procedures consistent with applicable regulations and/or specific payers; Interpretation of complex regulations and Department procedural billing policies; and supervisor of subordinate staff. The nature of assignments requires the ability to comprehend complex material to instruct staff and audit for appropriate outcomes.
ESSENTIAL JOB FUNCTIONS (examples, not all inclusive)
- Supervise, train, and instruct subordinate staff in the execution of various billing activities;
- Perform deep-dive audits, and review and analyze the output of Quality Assurance (QA) pre-and post-billed reports;
- Develop, maintain, and track various performance measures;
- Conducts specific audits to discern billing trends and identify performance improvements;
- Research and resolve complex billing issues;
- Monitoring billing activities to ensure compliance with billing regulations governing healthcare and Departmental policies;
- Ensure the accurate application of claim payments and the proper next billing step occurs;
- Determine the appropriate payer based on the circumstance of the transport and applicable State and Federal laws;
- Provide technical assistance on insurance verification, billing processes and procedures, and secondary billing actions;
- Maintain performance data and billing metrics;
- Handles elevated complaints from the public, vendors, or professional partners;
- 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;
- Conduct investigations and audits to resolve problems associated with misapplied funds or dormant accounts;
- Develop work plan and prioritize work assignment for subordinate staff;
- Performs a variety of tasks related to an automated office environment;
- Processes credit card payments via phone;
- Prepare status reports and performs special projects as required;
- Performs other related job duties as assigned.
QUALIFICATIONS
Education and Experience:
Six (6) years’ experience in supervision, work planning, medical billing, or claim analysis 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 supervising staff;
- 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.