What are the responsibilities and job description for the Claims and Compliance Coordinator position at GOLD CROSS AMBULANCE SERVICE-WISCONSIN?
Claims and Compliance Coordinator – Job Description
Job Title: Claims and Compliance Coordinator
Pay Classification: 1.0 FTE Hourly (non-exempt)
Department: Administration
Location: Administrative Office 1050 Wittmann Drive Menasha, WI
Position Overview: The Claims and Compliance Coordinator is responsible for overseeing the EMS claims process to ensure accurate and timely submissions, compliance with regulations, and effective communication between the EMS agency, billing company, and healthcare facilities. This role involves quality assurance of documentation, revenue tracking, and patient support to maintain smooth claims processing and regulatory adherence.
Key Responsibilities:
Claims Management & Revenue Tracking:
- Act as the primary liaison between the EMS agency and the billing company to ensure accurate and timely claims submission.
- Collaborate with quality assurance department (QA) on Patient Care Reports (PCRs) and required documentation before submission to the billing company.
- Analyze billing reports, trip reconciliation data, and bank reconciliation statements to maintain accurate revenue tracking.
- Ensure that the billing company has up-to-date transport rates for all EMS services and facility contracts.
- Manage the Additional Documentation Request (ACR/RTP) process with the billing company to ensure timely claim resolution.
- Process refund requests in accordance with company policies and industry regulations.
- Review and approve collections reports, ensuring compliance with company guidelines and best financial practices.
- Write off review and process oversight
Compliance & Documentation Oversight:
- Facilitate communication between Gold Cross, the billing company, and medical facilities to resolve documentation issues and discrepancies.
- Provide feedback to EMS crews regarding incomplete or inaccurate PCRs, promoting high-quality documentation practices in collaboration with the quality department.
- Collaborate and educate with healthcare facilities to obtain missing Physician Certification Statements (PCS) and other required documentation.
- Process and track medical record requests or coordinate their submission to the billing company as needed.
Patient & Provider Support:
- Assist patients with billing inquiries by coordinating responses between Gold Cross and the billing company as needed. May or may not include return mail processing
- Provide guidance to internal teams regarding claims processing and compliance requirements.
Other duties as assigned
Qualifications & Requirements:
- Education: High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration, finance, or a related field preferred.
- Experience: Prior experience in EMS billing, healthcare claims management, or medical compliance is highly desirable.
- Skills & Competencies:
- Strong knowledge of EMS claims processing, insurance billing, and regulatory compliance.
- Proficiency in medical documentation review and quality assurance.
- Excellent communication and problem-solving skills.
- Ability to analyze financial reports and reconcile revenue data.
- Strong attention to detail and organizational skills.
- Proficiency in Microsoft Office Suite (Excel, Word, Outlook) and billing software.
- Certifications (Within 1 year of hire):
- Certified Ambulance Documentation Specialist (CADs)
- Certified Ambulance Compliance Officer (CACO)
- Certified Ambulance Coder (CAC)
- Certified Ambulance Privacy Officer (CAPO)
Work Environment:
- Office-based position with occasional interactions with EMS crews and healthcare facilities.
- May require occasional travel for meetings or training sessions.
Job Type: Full-time
Pay: $26.77 - $35.18 per hour
Expected hours: 40 per week
Benefits:
- 401(k) matching
- Dental insurance
- Employee assistance program
- Health insurance
- Health savings account
- Life insurance
- On-site gym
- Paid time off
- Vision insurance
Ability to Commute:
- Menasha, WI 54952 (Preferred)
Ability to Relocate:
- Menasha, WI 54952: Relocate before starting work (Preferred)
Work Location: In person
Salary : $27 - $35