Medical Billing Specialist 1 or 2

Come work in a fast-paced high-energy office, utilizing your medical billing expertise. Pinellas County Ambulance Billing is one of the largest ambulance providers in the country and is the exclusive ambulance provider for Pinellas County.

Our vision is to be nationally recognized as the industry leader in ambulance billing.

This position is within the Program Services section of the Financial Services Division, which is part of Pinellas County’s Safety and Emergency Services Department.

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.

Work for this position is performed onsite, Monday - Friday.

What Would You Do?

• Researches, verifies, updates, and assures the accuracy of information in the medical billing system.
• Research and resolve claim errors, e.g., verify failures, claim rejects, etc.
• Electronic claims submission, file retrieval, naming, and filing through Waystar, EOB / ERA manual retrieval through payer portals.
• Submission and reconciliation of claims sent to the Collection Agency to include Collections reports.
• Run routine Quality Assurance reports related to claim submissions and special projects to resolve issues with claims identified.
• Perform Quality Assurance (QA) reviews or pre-and post-billed ambulance, discerning any favorable or unfavorable billing patterns or trends.
• Conversion of incoming mailbag, USPS, faxes, emails to PDF files following documented scanning procedures.
• Coordinate and mailing of paper claims and supporting documentation as applicable.
• Return Mail Adhering to the guidelines and processing appropriately.
• Incoming Mail Sorting accurately and dispersing to the appropriate parties.
• Additional Information Correspondence folder Submitting the additional information requested from the insurance.
• Additional Information Workflows Reviewing each of the workflows to determine the appropriate action.
• All Incoming Correspondence (except Medicare appeals & Jail denials) documenting accounts and processing what is received.
• Support Document Management activities such as sorting and archiving.
• Resolve assigned tickets through the Ticketing System adhering to the service level agreement.
• Add payers and correct payer information.
• Determine the appropriate payer based on the circumstance of the transport and applicable State and Federal laws.
• Apply medical billing knowledge for insurance verification procedures.
• 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 past actions and to determine next steps.
• Handle resolution of EOB issues with insurance carriers.
• Performs a variety of tasks related to an automated office environment.
• Prepare status reports and performs special projects as required.
• Performs other related job duties as assigned.

What Do You Need To Have?

• Proficiency with Microsoft Windows, Word, Excel, and Adobe Acrobat.
• Proficiency with working with various automated software applications.
• Employee’s name must not appear on the Health & Human Services exclusion list.
• Other knowledge, skills, abilities, and credentials required for a specific position.
• Assignment to work a variety of customer service and administrative tasks including compulsory work periods in special, emergency, and / or disaster situations.

Medical Billing Specialist 1

• Three years’ experience in medical billing, claim analysis, denial review, or secondary billing workflow functions; or
• An equivalent combination of education, training, and / or experience.

Medical Billing Specialist 2

• Five years’ experience in medical billing, claim analysis, denial review, or secondary billing workflow functions; or
• An equivalent combination of education, training, and / or experience.

Our Benefits Rank Among The Top In The Area!

• Our benefits rank among the top in the area! Check it out!
• Looking for a strong retirement? We have you covered as members of theFlorida Retirement System (FRS) with investment and pension options.
• We have deferred compensation programs and wellness centers to name a few perks.Check out these and more!

Want to Learn More?

Please review the full classification description with the Physical / Mental Demands, Working Conditions, and Knowledge, Skills, and Abilities at the below link.