Billing Specialist - Full Time

Key Responsibilities

• Ensure all billing practices adhere strictly to federal and state healthcare regulations, including Health Insurance Portability and Accountability Act (HIPAA).
• 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.
• Contact healthcare providers to obtain necessary documentation or clarification regarding claims to ensure timely and accurate submission of claims.
• Communicate with insurance providers to secure prior authorizations for ambulance services, following up as needed to ensure timely approval.
• Accurately apply ICD-10 and HCPCS codes to transport services, mileage, and supplies, and submit claims within timely filing limits.
• Review and monitor status on submitted claims to ensure successful receipt by payors. Following up as necessary with insurance coverage and updating patient accounts.
• Enter complete and accurate patient and trip information into the company's billing system and maintain detailed records of all transactions and communications.
• Review and correcting any billing errors to minimize claim denials.
• Track reimbursement statuses, correct claim rejections, and submit detailed appeals for denied claims.
• Post insurance reimbursements and patient payments into the billing database, reconcile accounts, and process refunds if necessary.
• Address customer service inquiries, explain the ambulance billing and collections process, and establish payment plans.
• Ensure all activities and documentation adhere to company policies, healthcare regulations, and insurance requirements. Strictly adhere to HIPAA regulations, maintaining the confidentiality of sensitive medical and financial data.
• Collaborate closely with Dispatch to ensure trips are financially cleared in a timely and organized manner, allowing for the efficient dispatch of ambulance units.
• Provide exceptional customer service by addressing facility/patient inquiries, resolving issues, and maintaining a professional and empathetic demeanor during all interactions.
• Maintain knowledge of and comply with all company policies, procedures, and guidelines at all times.

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