Medical Biller/Coder

Summary

Responsible for knowing, understanding, and following Insurance billing regulations for Non-Emergency and Emergency Ambulance billing. Running and providing department reports for monitoring purposes. Completing and maintaining projects assigned for Medicare/Medicaid.

Key Responsibilities

• Responsible for ALL aspects of Billing and Collections for 911 and Non-Emergency Ambulance Service Provider such as Medicare, Medicaid, insurance denials.

• Liaison between senior management, employees, and clients to ensure proper lines of communication critical in addressing a myriad of problems and issues requiring immediate attention and resolve.

• Provide general administrative and clerical support including but not limited to receiving, maintaining medical records, faxing, copying & scanning.

• Responsible for training and coaching team members on new and/or existing procedures.

• Responsible for daily/ weekly & monthly reporting of following reports & Medicare application compliance items.

• Attending industry Webinars/ Conferences and preparing summary to ensure we are up to date with industry & billing compliance standards.

• Responsible for reviewing PCS forms to expedite claim submission & collections.

• Submitting RR Medicare record requests.

• Work closely with Department Managers/ Supervisors to create improvement & implement processes to ensure department goals and objectives are met on in a consistent basis.

• Submitting Medicare appeal via Medicare online portal to expedite payment.

• Review weekly CDI lists to ensure accounts are updated timely in effort to expedite claim submission & payment.

• Work on Medicare/ Medicaid denials to Identify trends & expedite claims processing & payment.

• Responsible for completing department projects as assigned that will assist in trend analysis, compliance & revenue improvement.

POSITION QUALIFICATIONS

Education & Experience

• High School Diploma, Associate degree preferred.
• Certified Ambulance Coder (CAC) or Certified Professional Coder (CPC) preferred.
• Extensive Medicare and Medicaid experience and understanding medical necessity in ambulance transportation.
• Ambulance/Medical billing certification or diploma preferred.
• Maintain working knowledge of ICD-10, CPT and HCPCS coding, NPI, HIPAA, Modifiers, EPCR’s and all forms of medical billing (direct, 3rd party, HMO’s, private pay, no-fault, worker’s comp, Medicare & Medicaid
• Excellent organizational skills and the ability to multi-task in a fast-paced environment
• Review and research data; use intuition and experience to complement data.
• Thorough knowledge of transport documentation (PCRs)
• Ability to follow up on outstanding Medicare accounts.
• Ability able to submit appeals and overpayment requests.
• Familiar with Medicare/CMS requirements and guidelines.
• Health Insurance Portability and Accountability Act (HIPAA) requirements and record retention compliance.
• Excellent written and verbal communications skills required · Excellent documentation skills (promptness, accuracy, thoroughness, and legibility).

• PCS/ Medical necessity.

• Customer Service/ Client relations.

Competencies

• Working knowledge of EMS systems/private ambulance and medical transportation systems preferred.
• Knowledge of CONNEX preferred.
• Knowledge Microsoft Word, Microsoft Excel, and Microsoft Windows.
• Familiarity with medical terminology
• Organizational and leadership abilities, detail oriented.

Work Environment

• Work is performed under normal working conditions, as in a standard office environment.

Physical Requirements

• High level of sitting/working at a desk
• Light physical effort (lift/carry up to 10 lbs.)
• Must be able to perform the essential duties of the position with or without reasonable accommodations.