City of Austin - JOB DESCRIPTION

Ambulance Billing and Coding Representative I

Under limited supervision, using independent discretion and judgement, this position performs advanced-level ambulance billing, recordkeeping, and accounting tasks related to the recovery of revenue for all billable services provided by Austin-Travis County EMS. 

1. Receives and answers customer service inquiries, requests, and complaints from the public related to ambulance billing. Responds verbally and in writing while complying with HIPAA, other public record laws, and confidentiality.
2. Investigates and gathers information on accounts using a wide variety of resources within the scope of Local, State and Federal laws.
3. Daily contact with confidential medical and credit information requiring knowledge and compliance with laws related to the custody, security, and release of this information.
4. Reviews pre-hospital care reports for completeness and accuracy of information for billing. Researches and enters patient, financial, diagnostic, and statistical information into billing system.
5. Determines order of primary, secondary, or other responsible parties for ambulance fee charges and bills appropriately following Medicare or Medicaid rules.
6. Determines appropriate level of care and medical necessity to assign proper diagnosis codes, and charges based on patient care documentation as defined by Centers for Medicare and Medicaid Services (CMS) guidelines.
7. Electronically submits healthcare-related forms to payers in accordance with filing deadlines. Prints, reviews, and mails billing statements for claims, and follows up to expedite payment in a timely manner.
8. Collects cash and electronic payments. Posts and balances payments on ambulance accounts. Processes refunds and write-offs for management approval.
9. Receives and processes rejected or denied claims and initiates appeal process. Works aging reports to optimize cash flow.
10. Corresponds verbally and in writing with patients, third-party payers, and insurance carriers on claim denials and past due accounts for resolution of payment issues.

• None.

• Knowledge of medical, insurance, and healthcare terminology.
• Knowledge of medical terminology and general anatomy.
• Knowledge of Local, State, and Federal laws, including HIPAA, Medicare, Medicaid, and other public health plans.
• Knowledge of accounting and bookkeeping practices and concepts, as well as cash handling and account collection procedures and practices.
• Skill in medical coding.
• Skill in insurance verification.
• Skill in establishing and maintaining good working relationships to internal and external customers.
• Skill in using computers and related software applications, multiple line phone systems, credit card machines, and online credit card payment systems.
• Skill in handling multiple tasks and prioritizing.
• Skill in data analysis and problem solving.
• Skill in effective oral and written communication.
• Skill in reviewing (proofreading) material to ensure accuracy, completeness, and adherence to established formats.
• Skill in interpreting and analyzing applicable data.
• Ability to provide exceptional customer service.
• Ability to understand and communicate technical information.
• Ability to exercise discretion in confidential matters.
• Ability to establish and maintain effective working relationships with City employees and the public.
• Ability to work under pressure with frequent interruptions and changes in priorities.
• Ability to manage conflicts and concerns and work with difficult customers.

Graduation from an accredited high school or equivalent, plus two (2) years of experience with medical terminology, medical insurance, and medical billing and coding principles and practices.