Billing Specialist Clearfield EMS - 17496

Key Responsibilities

• Submit clean, accurate ambulance claims in a timely manner
• Ensure compliance with CMS ambulance billing guidelines
• Review documentation for medical necessity, PCS forms, narratives, and mileage
• Manage accounts receivable and aggressively follow up on unpaid claims
• Resolve denials, underpayments, and rejections
• Prepare and submit appeals as needed
• Post and reconcile payments accurately
• Identify trends in denials and underpayments and recommend corrective actions
• Communicate with operations regarding documentation deficiencies
• Track and report billing KPIs, including clean claim rate and A/R aging
• Assist with audits, payer requests, and compliance reviews

Required Qualifications (Non-Negotiable)

• Minimum 1 year of ambulance/medical billing experience OR NAAC Certified Ambulance Coder
• Strong knowledge of:
  • Medicare and MA ambulance billing guidelines
  • Managed care plans
  • Levels of Service Billing requirements
  • PCS forms and medical necessity documentation
  • Modifiers, base rates, and mileage billing
• Proven experience with denial management and appeals
• Ability to independently manage A/R and follow-ups
• High attention to detail and strong organizational skills
• Knowledge of HIPAA and Patient Privacy and Compliance Laws