Billing Specialist

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. 

Key Responsibilities

Compliance: Ensure all billing practices adhere strictly to federal and state healthcare regulations, including Health Insurance Portability and Accountability Act (HIPAA). 

• 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.

Education & Experience:

• 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

Licensure, Certification, Registration:

• Not Applicable to this role as a requirement

Knowledge, Skills and Abilities:

• 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 (HER) systems
• Working knowledge of Web based applications and Microsoft Office, including Excel and Word required
• Communicate effectively, both verbally and in writing; ability to understand and carry out verbal and written instructions.
• Analytical skills to gather and interpret data
• Ability to exercise sound judgment and discretion at all times
• Strong interpersonal skills, resolving issues quickly and efficiently 
• Excellent organization skills: attention to detail and follow-through
• Able to multitask, take charge and ownership of tasks
• Ability to work independently and in a team setting
• Handle highly confidential information with complete discretion
• Ability to work in a fast paced, high demand environment

Requirements:

• Must be minimum of 18 years of age 

• Ability to meet the essential duties and physical, mental and sensory requirements of the position at all times. 
• Comply with UDS drug screening at any and all times

• Completion and receipt of satisfactory background check and MA CORI (Criminal Offender Record Information), verification may be required annually.

The physical demands described here are representative of those that must be met and maintained by an employee to successfully perform the essential functions of the job. 

Physical Requirements

• Stationary Position: Frequently required to sit for long periods at a desk.
• Manual Dexterity: High level of finger dexterity to operate computers, calculators, and office machinery.
• Handling/Reaching: Frequent need to reach with hands/arms, handle files, and feel objects.
• Lifting/Moving: Ability to lift, carry, or move documents, files, or office equipment (typically up to 10-25 pounds).
• Movement: Intermittent walking, standing, bending, or stooping to access files

Mental/Cognitive Requirements

• Organization: Exceptional organizational and time-management skills to handle daily tasks.
• Attention to Detail: Ability to input data accurately and read fine statistical reports.
• Communication: High-level verbal and written communication skills, including professional telephone etiquette.
• Problem-Solving: Ability to manage deadlines and resolve issues

Sensory Requirements

• Vision: Close vision, peripheral vision, depth perception, and ability to adjust focus to read computer screens and printed documents.
• Hearing: Ability to hear and understand speech in person and on the telephone.

Speech: Ability to communicate clearly in person and via phone.