City of Tucson

This classification is a lead position affording guidance to Ambulance Billing Specialist I and II. This lead position also reviews workloads and assists with training and performance measures. This classification performs billing and audit of Advance Life Support transport claims and necessary follow-up with Medicare, Medicaid, primary and secondary insurance companies, and private payers to ensure claim accuracy.

This classification will have broad knowledge of all federal and state regulations applying to each individual insurance carrier. Employees in this classification must be able to understand and apply appropriate ICD-10 codes, medical terminology and human anatomy for billing purposes. Employees in this classification must be able to demonstrate a complex understanding of Medicare and Medicaid regulations and the EMS practice management software.

Verifies service details, including pick-up and drop-off addresses, date and time, call type, response priority and transport priority.

Verifies patient demographics, including name, address, date of birth, social security number, insurance information and eligibility, and updates as needed.

Ensures trip tickets received is equal to the total trips for that day by reviewing dispatch logs and patient care reports. Utilizes EMS practice management software to enter necessary claim details and patient information.

Reviews patient care reports and medical reports for medical necessity and to apply the appropriate service code, ICD-10 diagnosis code, condition code, and origin/destination modifier.  

Initiates clean electronic or paper claims to the appropriate payer source to ensure timely reimbursement from payers and patients. Communicates between patients and payers regarding the status of claims and to help resolve issues by providing requested information.

Performs complex claim corrections, appeals, and follow up activities with payers and patients. Processes payments, downloads payment reports, processes electronic fund transfers, paper checks and credit cards. Prepares and reconciles daily deposits.

Provides guidance and coaching to Ambulance Billing Specialists. Assists in the development and monitoring of performance measures, training and procedures.

Audits medical claims for compliance with federal, state, and local regulations and policies. Analyzes denial trends and makes necessary system changes to resolve them. Reviews appropriate payer and government web sites and attends continuing education seminars in order to stay abreast of industry changes.

Minimum Education Level & Type: 6 months Post High School

Minimum Experience Qualifications: At least 3 years of experience in medical or ambulance billing and ICD coding

FLSA Status: Non-Exempt

Occupational Group Code: 07

Occupational Group Description: Accounting & Fiscal 

EEO Job Category Code: F

EEO Job Category Description: Office and Clerical

Organizational Level: Lead

NCCI: 8810

Bargaining Unit: CWA

The following information pertains to driving requirements for this classification with the City of Tucson. Under "Driving Level" None, Secondary or Primary, refers to the driving responsibility as it relates to the essential functions of the classification. License Type, is just that, the type of Arizona Driving License required for the classification. If the position requires a Commercial Drivers License (CDL), the endorsements will be listed under "Endorsements." Under Safety Sensitive a "Yes" means employees with this classification are subject to pre-employment and random drug testing. License Type A,B,C,D,or M may require the use of personal or City vehicles on City business. Individuals must be physically capable of operating the vehicles safely, possess a valid license and have an acceptable driving record. Use of a personal vehicle for City business will be prohibited if the employee is not authorized to drive a City vehicle or if the employee does not have personal insurance coverage. Exceptions to classification driving requirement's may exist based on position.

Driving Level: Secondary

License Type: Valid and Unrestricted Class D - Driver

CDL Endorsements: None

Safety Sensitive: No