Sr Medicare Biller

Position Summary

The Senior Medicare Biller is responsible for overseeing and managing Medicare billing processes for ambulance transports in compliance with federal, state, and payer-specific regulations. This role requires advanced knowledge of Medicare ambulance billing, New York State Medicaid coordination, documentation requirements, and appeals processes. The Senior Medicare Biller serves as a subject matter expert and ensures timely and accurate reimbursement while maintaining compliance with all regulatory standards.

Key Responsibilities

• Process, review, and submit Medicare claims for emergency and non-emergency ambulance services in accordance with CMS and New York State regulations
• Ensure accurate coding, modifiers, mileage, and level-of-service billing (BLS, ALS1, ALS2, SCT)
• Review documentation for medical necessity, physician certification statements (PCS), trip reports, and supporting records
• Identify, research, and resolve Medicare denials, underpayments, and rejections
• Prepare and submit redetermination, reconsiderations, and higher-level appeals as needed
• Cookier cross-over claims to New York State Medicaid and other secondary insurers
• Maintain compliance with CMS guidelines, OIG standards, HIPAA, and company policies
• Monitor aging reports, follow up on unpaid or delayed claims, and ensure timely resolution
• Act as a resource and mentor to billing staff, providing training and guidance on Medicare-related issues
• Assist with audits, compliance reviews, and internal quality assurance initiatives
• Communicate effectively with Medicare Administrative Contractors (MACs), Medicaid, and internal departments
• Stay current on Medicare policy updates, fee schedule changes, and regulatory requirements

Qualifications

• Minimum of 3–5 years of Medicare ambulance billing experience required
• In-depth knowledge of CMS ambulance billing regulations and New York State billing practices
• Strong understanding of medical necessity requirements and documentation standards
• Experience with Medicare appeals and denial resolution
• Proficiency with ambulance billing software and electronic claim submission systems
• High attention to detail and strong analytical skills
• Ability to prioritize workload and meet deadlines in a fast-paced environment
• Excellent written and verbal communication skills
• Ability to maintain confidentiality and comply with HIPAA regulations

Preferred Qualifications

• Experience with New York State Medicaid, No-Fault, and Workers’ Compensation coordination
• Prior supervisory or lead billing experience
• Familiarity with compliance audits and payer reviews
• CAC, CPC, CPB, or other relevant billing/coding certification