Medical Billing Specialist I, (A242913-1), 202, Ambulance

GENERAL SUMMARY

Handles new claims, posting payments and appeals of lower complexity. Provides customer service and processes medical and billing record requests.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by employees in this job. Employees may be requested to perform job-related tasks other than those specifically presented in this description.

• Reviews, generates, and processes emergency ambulance transport medical claims

• Determines appropriate CPT and ICD 10 codes based on the medical data and narrative furnished in ePCR (electronic Patient Care Report) and if additional medical information of ePCR is needed to bill accordingly

• Serve as additional support staff to manage the numerous amount of medical claims that come from EMS related services

• Retrieves hospital face sheets to obtain health insurance information and reviews and researches additional health insurance portals, if necessary

• Determines primary, secondary and/or tertiary insurances sequences based on insurance coverage per patient

• Submits CMS1500 forms when necessary

• Transmits electronic claims and reviews transmission reports for accepted and rejected claims.

• Responsible for reviewing our claim batches to ensure it cleared the billing system and the clearinghouse's claim checks

• Reviews medical and billing record requests in response to subpoenas, attorneys, hospitals, insurances, record retrieval companies and other companies or other organization requests

• Prepare, invoice, and submit all medical and billing record and affidavit requests to respective parties

• Provides customer service to patients in person and/or by telephone and is responsible for resolving reason for visit or call

• Is responsible for taking payments, in person or over the phone

• Reviews incoming correspondence and distributes accordingly

• Assists in daily work assignments of lower complexity and any other clerical work assigned by program supervisor

• Will be required to drive a City vehicle for Ciiy business use

• Performs other duties as assigned

COMPETENCIES FOR SUCCESSFUL PERFORMANCE OF JOB DUTIES

Knowledge of:

• Knowledge in ICD-10, CPT, and HCPCS medical coding

• Knowledge in Medicare and Medicaid guidelines

• Knowledge in health insurance claim submission and collections

• Knowledge of HIPAA guidelines

• Knowledge of complex medical office clerical and billing services and operations

Skills and Abilities

• Ability to solve mathematical problems pertaining to patient accounts and billing functions.

• Ability to build and maintain effective working relationships with others

• Ability to communicate clearly and effectively both orally and in writing

• Ability to maintain good planning and organizational skills

• Ability to take and follow directions from supervisor

• Ability to give directions to and gain compliance from assigned staff

• Ability to maintain a valid Texas Driver License and a good driving record

• Ability to project a positive and professional image of the City of Laredo

• Ability to effectively communicate both orally and in writing in the English language and orally in the Spanish language

• Ability to comply with all City of Laredo's policies and procedures

• Ability to maintain good health and physical condition sufficient to permit the full performance of the duties of this position

WORK ENVIRONMENT/CONDITIONS AND PHYSICAL DEMANDS

Physical Effort Requirements Position will have the following exposures

• Office or similar indoor environment, relatively free from unpleasant environmental conditions or hazards.

• Exerting up to 35 pounds of force occasionally, up to 20 pounds of force frequently, and/or up to 20 pounds of force constantly having to move objects.

Work Environment Locations Position will require the employee to work in the following types of work environments

Never

• Street environment (near moving traffic)

• Construction site

• Confined space

• Vehicles

• Warehouse environment

Seldom

• Outdoor environment

Often

• Office or similar indoor environment

Exposures Position will require the employee to be exposed to the following environmental elements

Never

• Extreme cold (below 32 degrees)

• Moving mechanical parts

• Fumes or airborne particles

• Toxic or caustic chemicals or substances

• Loud noises (85+ decibels such as heavy trucks, jack hammers, construction)

Seldom

• Individuals with known violent backgrounds

• Extreme heat (above 100 degrees)

• Communicable diseases

Sometimes

• Individuals who are hostile or irate

Travel Position will require the employee to travel

Never:

• International travel

Seldom:

• Regional travel

• National travel

Sometimes:

• Local travel

Required Education and Experience

• High School Diploma or G.E.D.

• At least six (6) months of experience in medical coding, working with Medicare or Medicaid, working with insurance claims, or clerical experience in a medical office.

Proof of TB Test/Screening will be required to be presented prior to employment

Required Licenses or Certifications

• Billing and Coding certification must be obtained within 12 months of employment

Continued employment is contingent on successfully obtaining required certification(s) and/or license(s) within the specified period of time indicated above from time of hire.

Valid Texas Drivers License. If applicant holds an out-of-state license, a State of Texas Driver License must be obtained within 6 months of employment.

As part of the minimum requirements for all positions with the City of Laredo, a thorough background check and certified school transcripts will be required from all applicants who are offered employment.

Effective February 24, 1997, all selected applicants are required to undergo a drug and alcohol test prior to employment.

Effective January 7, 2008, all persons in safety-sensitive functions/positions, as per City of Laredo Drug and Alcohol Policy definition, shall be subject to random drug and alcohol testing.

A person with a disability who needs a reasonable accommodation related to a selection process is requested to contact the Human Resources Department at (956) 791-7480, two days prior to the scheduled test or interview.

City of Laredo is an Equal Opportunity/Affirmative Action/Pro Disabled and Veteran Employer. We welcome differences in the form of gender, race, ethnicity, disability, geography, socioeconomic status, age, politics, religion, philosophy, sexual orientation, or gender identity. All applicants who share this goal are encouraged to apply. Must be able to function in a principle-based organization that has a culture built on character and core values.