POSITION SUMMARY
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
1. Examines patient care reports to gather essential information for insurance documentation.
2. Contacts facilities, hospitals, or patients to acquire missing information and physician certification statements.
3. Collects data such as insurance company names, policyholder details, policy numbers, and services provided to accurately complete claim and/or billing records. 4. Communicates with insurance companies to verify coverage, determine payor schedules, and gather benefit details.
5. Assigns relevant codes based on documented information in the patient care report and determines the appropriate level of ambulance service.
6. Allocates charges for services supported by documentation in the patient care report.
7. Reviews medical records to assess the medical necessity of ambulance transport and enters suitable ICD, CPT, or HCPCS code for claims.
8. Verifies the presence of all required documents before submitting reimbursement claims to ensure inclusive records.
9. Calculates total bills, indicating amounts payable by insurance and patients, and processes claim submissions by mail or electronically.
10. Ensures each account is billed to the correct payer following the appropriate billing schedule.
11. Follows up with companies and individuals regarding unpaid claims to secure payment.
12. Communicates in a professional manner when addressing patients' and families' questions regarding statements, in order to provide accurate information.
13. Prepares outgoing mail, bills, invoices, statements, and reports.
14. Manages denial resolution and accounts receivable follow-up.
15. Posts payments and compiles reports.
16. Performs charge entry tasks.
17. Handles aging accounts.
18. Commitment to maintaining confidentiality and compliance with HIPAA and other privacy regulations.
19. Performs other duties as required or assigned.
EDUCATION/EXPERIENCE
1. High school degree or GED required
2. One year of experience with medical billing and coding systems, or a certificate for medical coding, preferred
3. Knowledge of medical billing software preferred
KNOWLEDGE/SKILLS/ABILITIES
1. Knowledge of the Health Insurance Portability and Accountability Act (HIPAA) 2. Knowledge of procedure and diagnostic codes (HCPCS and ICD-10 codes) 3. Knowledge of medical terminology, abbreviations, and acronyms 4. Knowledge of medical billing
5. Attention to detail to review records and claims for errors or discrepancies 6. Strong communication skills are required to clearly explain procedures and resolve issues with providers, insurers, and patients
7. Understanding of various insurance plans and procedures
8. Ability to work independently and collaboratively
9. Ability to prioritize tasks and meet deadlines
10. Intermediate Microsoft Office and Google Workspace skills
PHYSICAL REQUIREMENTS
1. Talking – expressing or exchanging ideas by means of the spoken word to impart oral information to others accurately (1-2 hrs. daily).
2. Hearing – perceiving the nature of sound by ear (1-2 hrs. daily). 3. Sitting – remaining in a seated position (6-8 hrs. daily).
4. Lifting – raising or lowering an object under 20 lbs. from one position to another (infrequently).
5. Work Environment – general office work and exposure to elements within the office environment (6-8 hrs. daily).
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