Ambulance Billing Accounts Receivable Specialist

Clay County Board of County Commissioners • Administration Building - 4th Floor, FL

1d • $23 - $27 • Onsite

About The Position

Under the general direction of the Ambulance Billing Manager, this role manages and resolves 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). This posting covers all three tiers; candidates will be placed at the level that matches their qualifications and experience, with salary determined accordingly.

Requirements

• Medical billing experience is required.
• Minimum of two (2) years of progressively responsible related experience in ambulance/EMS billing or medical billing (for Specialist I).
• Minimum of three (3) years of progressively responsible experience in ambulance/EMS billing or medical billing (for Specialist II).
• 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 (for Specialist II).
• Demonstrated knowledge of payment recoupments, account validation, documentation standards, and refund processing for payers and patients (for Specialist II).
• 5+ years of recent ambulance/EMS or medical billing experience, including high-volume claims processing (for Specialist III).
• Demonstrated full-cycle billing skills: charge entry, coding, claim submission, payment posting, A/R follow-up, and denial management (for Specialist III).
• Strong working knowledge of Medicare, Medicaid, and commercial payer rules for ground ambulance, including medical necessity and PCS requirements (for Specialist III).
• Proficiency with medical/EMS billing software and practice management systems; strong keyboarding and data entry accuracy (for Specialist III).
• Ability to read and interpret patient care reports and supporting documents to ensure claims meet payer and audit standards (for Specialist III).
• 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.

Nice To Haves

• Knowledge of other state-specific guidelines is preferred.

Responsibilities

• 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.
• Proficiency in claim denial resolution, payment posting, refunds, and payer follow up.
• Maintain knowledge of Medicare, Medicaid, and Florida specific ambulance billing guidelines.
• Respond and perform emergency/recovery duties as assigned during a declared emergency or crisis situation (hurricane, flood, etc.), 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.
• 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.
• Identify and correctly bill dual healthcare coverage per coordination of benefits rules (e.g. primary vs. secondary payer sequencing).
• Work 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 clearly met.
• 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-dollar 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.
• Interpret and apply reimbursement policy in audit, appeal, and regulatory contexts; review and approve high-risk, high-dollar, 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.
• 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.

Benefits

• Continued success depends on it!
• Our growth is creating great opportunities!
• Our team is expanding, and we want to hire the most talented people we can.
• So once you've had a chance to explore our current open positions, apply to the ones you feel suit you best and keep track of both your progress in the selection process, and new postings that might interest you!
• Thanks for your interest in working on our team!!
• Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people.
• Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful.
• They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED