Ambulance Medical Biller & Coder

About the role

This role is responsible for accurately and appropriately coding ambulance claims, including claim submission, follow-up on denied claims, and ensuring compliance with relevant billing regulations to facilitate timely reimbursement for services.

Essential Job Functions

• Examines patient care reports to gather essential information for insurance documentation.
• Contacts facilities, hospitals, or patients to acquire missing information and physician certification statements.
• Collects data such as insurance company names, policyholder details, policy numbers, and services provided to accurately complete claim and/or billing records.
• Communicates with insurance companies to verify coverage, determine payor schedules, and gather benefit details.
• Assigns relevant codes based on documented information in the patient care report and determines the appropriate level of ambulance service.
• Allocates charges for services supported by documentation in the patient care report.
• Reviews medical records to assess the medical necessity of ambulance transport and enters suitable ICD, CPT, or HCPCS code for claims.
• Verifies the presence of all required documents before submitting reimbursement claims to ensure inclusive records.
• Calculates total bills, indicating amounts payable by insurance and patients, and processes claim submissions by mail or electronically.
• Ensures each account is billed to the correct payer following the appropriate billing schedule.
• Follows up with companies and individuals regarding unpaid claims to secure payment.
• Communicates in a professional manner when addressing patients' and families' questions regarding statements, in order to provide accurate information.
• Prepares outgoing mail, bills, invoices, statements, and reports.
• Manages denial resolution and accounts receivable follow-up.
• Posts payments and compiles reports.
• Performs charge entry tasks.
• Handles aging accounts.
• Commitment to maintaining confidentiality and compliance with HIPAA and other privacy regulations.
• Performs other duties as required or assigned.

Education/Experience

• High school degree or GED required
• One year of experience with medical billing and coding systems, or a certificate for medical coding, preferred
• Knowledge of medical billing software preferred

Knowledge/Skills/Abilities

• Knowledge of the Health Insurance Portability and Accountability Act (HIPAA)
• Knowledge of procedure and diagnostic codes (HCPCS and ICD-10 codes)
• Knowledge of medical terminology, abbreviations, and acronyms
• Knowledge of medical billing
• Attention to detail to review records and claims for errors or discrepancies
• Strong communication skills are required to clearly explain procedures and resolve issues with providers, insurers, and patients
• Understanding of various insurance plans and procedures
• Ability to work independently and collaboratively
• Ability to prioritize tasks and meet deadlines
• Intermediate Microsoft Office and Google Workspace skills

Physical Requirements

• Talking – expressing or exchanging ideas by means of the spoken word to impart oral information to others accurately (1-2 hrs. daily).
• Hearing – perceiving the nature of sound by ear (1-2 hrs. daily).
• Sitting – remaining in a seated position (6-8 hrs. daily).
• Lifting – raising or lowering an object under 20 lbs. from one position to another (infrequently).
• Work Environment – general office work and exposure to elements within the office environment (6-8 hrs. daily).