Billing Specialist - Full Time

The Billing Specialist – is a Medical Biller that manages the full revenue cycle for emergency and non-emergency transports. Is responsible for maintenance of accurate billing records of complex customer and patient accounts, and communicating with customers to answer questions or provide information as needed.

Accurately submitting claims to Medicare, Medicaid, commercial insurers, handling claim denial management, verifying coverage, and auditing Emergency Medical Service (EMS) Transports to ensure proper CMS compliance. This position requires a blend of healthcare administration, financial tracking and billing software proficiency.

• Report Auditing: Review Patient Care Reports (PCRs) and Physician Certification Statements (PCS) to ensure medical necessity and determine the appropriate billing level (e.g., ALS vs. BLS) and appropriate ICD and Healthcare codes.
• Healthcare Provider Documentation:
  Contacting healthcare providers to obtain necessary documentation or clarification regarding claims to ensure timely and accurate submission of claims.
• Insurance Prior Authorizations:
  Communicate with insurance providers to secure prior authorizations for ambulance services, following up as needed to ensure timely approval.
• Claims Processing: Accurately apply ICD-10 and HCPCS codes to transport services, mileage, and supplies, and submit claims within timely filing limits.
• Claim Management:
  Review and monitor status on submitted claims to ensure successful receipt by payors. Following up as necessary with insurance coverage and updating patient accounts.
• Billing Information:
  Enter complete and accurate patient and trip information into the company's billing system and maintain detailed records of all transactions and communications.
• Claim Correction:
  Review and correcting any billing errors to minimize claim denials.
• Denial & Appeal Management: Track reimbursement statuses, correct claim rejections, and submitting detailed appeals for denied claims
• Payment Posting: Post insurance reimbursements and patient payments into the billing database, reconcile accounts, and process refunds if necessary.
• Patient Support: Address customer service inquiries, explain the ambulance billing and collections process, and establish payment plans
• Compliance & Privacy:
  Ensure all activities and documentation adhere to company policies, healthcare regulations, and insurance requirements. Strictly adhering to HIPAA regulations, maintaining the confidentiality of sensitive medical and financial data.
• Team
  
  Collaboration:
  
  Collaborate closely with Dispatch to ensure trips are financially cleared in a timely and organized manner, allowing for the efficient dispatch of ambulance units.
• Customer Service:
  Provide exceptional customer service by addressing facility/patient inquiries, resolving issues, and maintaining a professional and empathetic demeanor during all interactions.
• Consistently meets and maintains productivity goals and defined benchmarks on a weekly basis.
• Additional projects and responsibilities as assigned and requested.
• Maintains knowledge of and complies with all company policies, procedures, and guidelines at all times.

• High school diploma or GED equivalent is required. Post-secondary certification in medical billing or coding (CAC, CPB from AAPC or other) highly preferred.
• Minimum 2 years of Medical Billing experience
• Prior experience in EMS, Ambulance, transportation medical billing preferred

• Not Applicable to this role as a requirement

• Knowledge of HIPPA and Healthcare standards
• Knowledge of medical terminology, CPT/HCPCS codes, and ICD-10 coding.
• Knowledge and understanding of insurance coverages, fee schedules and regulations, Medicaid and Medicare Ambulance Guidelines, and private insurance reimbursement protocols.
• Knowledge of international payment and invoicing process a plus.
• Proficiency with medical billing software, electronic health records…