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Job description
Job Title
Handles new claims, posting payments and appeals of lower complexity. Provides customer service and processes medical and billing record requests.
Essential Functions/Job Competencies/Physical Requirements
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 City business use
Performs other duties as assigned
Competencies for successful performance of job duties:
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
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:
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.
Never: Street environment (near moving traffic), construction site, confined space, vehicles, warehouse environment
Seldom: Outdoor environment
Often: Office or similar indoor environment
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: Never: International travel
Seldom: Regional travel, national travel
Sometimes: Local travel
Minimum Qualifications
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
Valid Licenses and Certifications
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 , 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.
Benefits
The City of Laredo provides a benefit compensation package that includes the following for all Full-time regular employees:
10 days of paid vacation per year
6 1/2 days sick leave per year
Pension plan
16 paid Holidays
Paid health
Dental plan
Life insurance
* 30 day waiting period. For a full description of our benefits, please visit our website at: under Employee Benefits
Worksite address
laredo, TX, 78045, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.