Billing Auditor

Overview

The Billing Auditor plays a critical role in ensuring the accuracy, completeness, and compliance of all patient care documentation prior to billing. This position requires strong analytical ability, independent judgment, and exceptional attention to detail when reviewing electronic Patient Care Records (ePCRs), Physician Certification Statements (PCS), face sheets, and related documentation.

A core responsibility of this role is the continuous improvement of PCR quality. The Billing Auditor ensures each record meets payer, regulatory, and internal standards before submission to Care Flite’s third-party billing partner.

Equally essential is maintaining strong, collaborative relationships with ground crews by providing clarification, education, and real-time support to reinforce the importance of accurate billing documentation and its direct impact on Care Flite’s mission, patient advocacy standards, and documentation integrity.

The Billing Auditor serves as a key link between field operations, the Integrated Billing Services team, and external billing partners. This position ensures compliance with Medicare, Medicaid, commercial insurance requirements, HIPAA, state EMS regulations, and Care Flite policies, while supporting audits, reporting, and departmental process-improvement initiatives.

• Review daily ePCRs and associated documentation to ensure accuracy, completeness, compliance, and readiness for billing.
• Conduct pre-billing audits and return PCRs to crews for correction or clarification as necessary.
• Identify documentation trends affecting billing performance and communicate findings to Integrated Billing Services leadership.
• Review PCS forms, face sheets, signatures, mileage, and all documentation required for compliant EMS claims.

• Communicate daily with crew members who have pending, missing, or incomplete PCRs to ensure timely completion before the end of their shift.
• Assist crews with documentation or billing questions and provide clarification on payer requirements and documentation standards.
• Build and maintain positive relationships with crews to promote Care Flite’s mission, standards of patient advocacy, operational excellence, and documentation integrity.
• Participate in education initiatives, meetings, or targeted follow-ups to reinforce proper documentation practices.
• Provide feedback to assist in the development and refinement of documentation training materials, policies, and crew education initiatives.

• Obtain, scan, and attach required documents to the ePCR or billing software when not automatically linked.
• Support the Integrated Billing Services Manager, Billing Coordinator, and Custodian of Records with departmental needs as required.
• Document audit activities, findings, and communication per departmental procedures.

• Ensure adherence to federal, state, and organizational billing procedures, including Medicare, Medicaid, commercial payor requirements, and HIPAA.
• Maintain working knowledge of ambulance billing regulations, state EMS rules (including TAC 157), and internal Care Flite processes.
• Maintain strict confidentiality of medical and financial information in accordance with HIPAA and Care Flite policies.

• Communicate professionally and respectfully with internal staff, field crews, external partners, healthcare facilities, and third-party billing entities.
• Demonstrate regular attendance, punctuality, and the ability to perform duties independently.
• Attend at least 75% of quarterly staff meetings.
• Represent Care Flite in a courteous, professional manner with a positive customer service demeanor.
• Perform other duties as assigned while contributing to a respectful and collaborative work environment.

• Teamwork: Collaborates effectively with departments, field crews, and leadership to support accurate billing processes.
• Communication: Communicates clearly, respectfully, and professionally with internal and external stakeholders.
• Problem Solving: Applies critical thinking…