Fire Rescue EMS Billing & Claims Specialist

Full Job Description

Join a workforce where innovation and teamwork provide support to the community and citizens of Monroe County.

Compensation:

$0.00 - $9,999,999,999.00

Job Description:

The primary function of this position is to be responsible for report review, data entry, retrieval, and records maintenance of an air and ground EMS billing program; and for performing complex administrative work within the division of Emergency Services.

ESSENTIAL JOB FUNCTIONS

• Reviews ePCR reports to ensure complete and accurate patient demographic, trip, billing, and insurance information; refers incomplete or inaccurate records to EMS Quality Assurance.
  
• Extensive knowledge of medical terminology, CPT, HCPCS, ICD 10, and CMS 1500 Revenue Codes, modifiers, billing, rules, and recommendations for government and commercial payers.
  
• Verifies or assigns condition codes, modifiers, levels of service, and other relevant claim data.
  
• Scans and attaches biomedical and supporting trip records to electronic patient care reports.
  
• Greets customers in person and by telephone, receives account payments, and assists customers as necessary in the completion of insurance forms, Air Resident (Trauma Star) waivers, and records requests.
  
• Initiates pre-authorization for air ambulance transportation, if applicable for specific insurances.
  
• Assists Billing and Claims Supervisor with collection actions, including contacting patients by phone and arranging payments.
  
• Minimizes the number of aging accounts to maintain a consistent workflow by regularly following up on unpaid claims.
  
• Processes and posts Medicare, Medicaid, Automated Clearing House (ACH) payments, wire transfers, checks, and credit card payments on a daily basis. Reviews and processes refunds as needed.
  
• Reviews and follows up on accounts before transferring to an outside collection agency that have reached collections timeframe for accuracy.
  
• Processes Air Resident (Trauma Star) waivers.
  
• Processes legal records requests for patient care reports and response records.
  
• Performs monthly EMSTARS extract and data submission to Department of Health, State EMS Division to comply with mandatory pre-hospital reporting requirements.
  
• Reviews, processes, and responds to correspondence accordingly.
  
• Posts payments and denials accurately.
  
• Maintains several spreadsheets for billing reconciliation.
  
• Scans and maintains accurate day-to-day posting documents and correspondence in One Drive for audits and compliance purposes.
  
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations and County/Department Policies and Procedures.
  
• Needs to stay informed of regulatory changes with the ability to adapt and navigate the claim reimbursement and denials environment.
  
• Possess strong written communication and grammar competencies to generate appeal letters that are specifically tailored to the patient's level of illness, the quality of service, reason for denial, and capacity against which prompted denial.
  
• Processes RFPs, contracts, renewals, purchases, agenda items, special projects, and maintains records.
  
• Participates in any meetings, phone conferences, or webinars that may be required to process rejections effectively, acquire information about the appeals process, adapt to the latest regulations and laws, or comprehend the terms of payer contracts.
  
• Assists in budget preparation and monitoring expenses.
  
• Performs other related job duties as assigned.
  
• In the event of special, emergency, or disaster situations, employee may be required to work schedules other than those for which they are regularly scheduled in any capacity deemed appropriate.
  

QUALIFICATIONS

Education and Experience:

High school Diploma or GED required. 3 years minimum of prior related work experience preferred.

Special Qualifications:

Certified Ambulance Coder within one year of employment.

Knowledge, Skills, and Abilities:

• Ability to work from a general outline of duties and responsibilities.
  
• Ability to perform entry-level professional work including basic data analysis and synthesis, report creation, process performance, and regulatory or compliance activities.
  
• Ability to follow basic guidelines for operational activities.
  
• Ability to work with less than ten co-workers who are mostly engaged in the same activities as me.
  

PHYSICAL DEMANDS

The work is sedentary and 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:

• Manual Dexterity: Picking, pinching, typing, or otherwise working, primarily with fingers rather than with the whole hand as in handling.
  
• Mental Acuity: Ability to make rational decisions through sound logic and deductive processes.
  
• Repetitive Motion: Substantial movements (motions) of the wrist, hands, and/or fingers.
  
• Speaking: Expressing or exchanging ideas by means of the spoken word including the ability to convey detailed or important spoken instructions to other workers accurately and concisely.
  
• 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.
  
• Visual Acuity: Have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; and/or extensive reading.
  
• Walking: Moving about on foot to accomplish tasks, particularly for long distances or moving from one work site to another.
  

WORK ENVIRONMENT

Work is performed in a dynamic environment that requires sensitivity and responsiveness to changes that include goals, priorities, and needs of the organization and position.

Monroe County has the right to revise this job description at any time. This description does not represent in any way a contract of employment.

Equal Opportunity Employer: Monroe County does not discriminate on the basis of race, color, national origin, gender, religion, age, disability, or military service in employment or the provision of services.

Empleador de Igualdad de Oportunidades: El Condado de Monroe no discrimina por motivos de raza, color, origen nacional, género, religión, edad, discapacidad o servicio militar en el empleo o la prestación de servicios.

Veterans Preference according to Florida State Statute 295.07: Certain service members and veterans, and the spouses and family members of the servicemembers and veterans, receive preference and priority in employment by the state and are encouraged to apply for the positions being filled.
Preferencia de Veteranos de acuerdo con el Estatuto del Estado de Florida 295.07: Ciertos miembros del servicio y veteranos, y los cónyuges y familiares de los miembros del servicio y veteranos, reciben preferencia y prioridad en el empleo por parte del estado y se les alienta a solicitar los puestos que se están llenando.