Ambulance Billing Accounts Receivable Specialist

Pay: $22.93 - $26.83 Job Summary Under the general direction of the Ambulance Billing Manager, manage and resolve ambulance accounts receivable in accordance with payer requirements, regulatory standards, and organizational policies. This role ensures accurate insurance verification, modifier application, coordination of benefits, claim follow-up, denial resolution, and documentation integrity across varying levels of complexity. Responsibilities progress from rule‑based, transactional claim processing (Specialist I) to advanced analysis involving documentation review, payer‑specific interpretation, appeals, compliance risk assessment, and operational guidance (Specialist III). Candidates will be placed at the level that matches their qualifications and experience, with salary determined accordingly. Core Responsibilities (All Tiers) Perform insurance verification to confirm active coverage, payer sequence, and eligibility. Apply required ambulance billing modifiers accurately based on documentation and billing rules. Review Explanation of Benefits (EOBs) and Remittance Advice (RA/ERA) files and update claim status. Resolve claim denials, post payments, process refunds, and follow up with payers. Maintain knowledge of Medicare, Medicaid, and Florida‑specific ambulance billing guidelines. Respond to and perform emergency/recovery duties as assigned during a declared emergency or crisis situation, including potential presence at the Emergency Operation Center (EOC) while activated. Ensure adherence to HIPAA, County policy, and all applicable local, state, and federal regulations. Have working knowledge of ambulance‑specific coding (HCPCS Level II, CPT, ICD‑10). Familiarity with clearinghouses, ERAs, and electronic billing software. Solid computer skills, including use of Microsoft Office (especially Excel) and multiple web‑based billing platforms. Perform other related duties as assigned. Specialist I: Additional Responsibilities Identify and correctly bill dual healthcare coverage per coordination of benefits rules. Handle low‑complexity rejections and denials, including missing signatures, invalid/missing modifiers, and demographic errors. Generate and send patient statements and standard correspondence. Initiate standard appeal templates when eligibility and documentation criteria are met. Specialist II: Additional Responsibilities Review and interpret claim denials in the context of payer policy and documentation to determine appropriate correction or rebilling. Analyze denial trends to identify documentation deficiencies or payer misapplication of policy. Resolve complex coordination‑of‑benefits issues involving dual coverage, payer responsibility disputes, and secondary billing. Manage mid‑ to high‑value accounts requiring analytical judgment beyond standard rule‑based workflows. Prepare and submit formal payer appeals, including policy interpretation and supporting documentation. Review patient care reports and facility documentation to support billing, appeals, and reimbursement determinations. Provide guidance and informal coaching to Tier I staff on claims processing and common error trends. Escalate systemic, high‑risk, or payer‑wide billing issues to Tier III for policy‑level review. Specialist III: Additional Responsibilities Interpret and apply reimbursement policy in audit, appeal, and regulatory contexts; review and approve high‑risk, high‑value, or precedent‑setting determinations. Lead appeal strategies for systemic denials or payer misinterpretation; serve as final escalation point for unresolved billing and dual‑coverage issues. Partner with Contract Administration, County Attorney’s Office, and internal audit teams on reviews, investigations, and corrective actions; approve rebilling strategies, corrective action plans, and write‑offs. Develop training standards, documentation requirements, and reference materials related to claims processing. Prepare and analyze A/R and billing activity reports; identify process deficiencies and implement corrective actions to reduce risk. Collect, analyze, and report monthly expense variances with supporting explanations. Coordinate with external vendors on PEMT and GADCS expense reports; participate in monthly charge reconciliation. Act as subject‑matter expert and knowledge resource for the Billing Team; assume delegated decision‑making authority in the Billing Manager’s absence. Communicate complex billing, compliance, and financial information clearly and concisely through written reports and correspondence. Maintain accurate, complete, and auditable documentation of billing transactions and communications. Maintain information systems security through compliance with established policies, training, and reporting requirements. Additional Expertise and Communication Expert knowledge of Medicare, Railroad Medicare, Medicaid, and Florida‑specific ambulance billing guidelines; knowledge of other state‑specific guidelines is preferred. Expert knowledge of claim denial resolution, including coding, documentation, and coordination of benefits. Expert knowledge of electronic billing systems, clearinghouses, and electronic remittance advice (ERA) processing. Exercises advanced professional judgment and independent decision‑making in matters with significant financial, regulatory, and audit exposure. Ensures institutional knowledge is standardized, documented, and consistently applied across billing operations. Provides leadership continuity and informed decision‑making when senior billing leadership is unavailable. Expert ability to communicate effectively with payer representatives and internal staff. Confident in providing technical guidance to Tier I and Tier II staff. Minimum Requirements Specialist I (Starting Pay: $22.93/hr) Medical billing experience required; minimum of two (2) years of progressively responsible related experience in ambulance/EMS billing or medical billing. Specialist II (Starting Pay: $24.31/hr) Minimum of three (3) years of progressively responsible experience in ambulance/EMS billing or medical billing; proficiency with government payer guidelines, including Tricare, VA, and Tricare for Life, and understanding of order‑of‑payment rules when traditional healthcare payers are involved; demonstrated knowledge of payment recoupments, account validation, documentation standards, and refund processing for payers and patients. Specialist III (Starting Pay: $27.31/hr) Five or more years of recent ambulance/EMS or medical billing experience, including high‑volume claims processing; demonstrated full‑cycle billing skills (charge entry, coding, claim submission, payment posting, A/R follow‑up, and denial management); strong working knowledge of Medicare, Medicaid, and commercial payer rules for ground ambulance; proficiency with medical/EMS billing software and practice management systems; ability to read and interpret patient care reports and supporting documents to ensure claims meet payer and audit standards. All Candidates Valid Florida Driver’s License with a clean driving record. High School Diploma or GED equivalent required. Any equivalent combination of education and experience that provides the required knowledge, skills, and abilities may be considered. Supplemental Information Regular attendance is an essential function of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. Employees may be required to perform duties, including normal work functions or other emergency support functions as deemed necessary by the County, before, during, and after hazardous weather or a state of local emergency. Working Environment and Physical Demands Mostly sedentary work. Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly, to lift, carry, push, pull, or otherwise move objects, including the human body. Noise level in the work environment is usually moderate. Equal Opportunity Employer Statement Clay County is an Equal Opportunity Employer dedicated to fostering a diverse workforce. We do not discriminate on the basis of race, color, religion, sex, national origin, disability, genetic information, or age. Clay County is committed to providing veterans with preference in employment opportunities in accordance with Florida State Law and Federal Regulations. As part of our dedication to supporting veterans, we ensure that qualified veterans are given preferential treatment in our hiring process, in accordance with Florida Statute 295.07. Eligible veterans who believe they were discriminated against may file a complaint with the Florida Department of Veterans’ Affairs within 60 days of receiving notice of non‑selection. #J-18808-Ljbffr Clay County Board of County Commissioners