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).
...England from our headquarters in Canton, Massachusetts.The Network Engineer will provide installation, maintenance, and support services... ..., Information Technology, or another related field~Some internship or professional experience in IT or telecommunications preferred...
...States. The safety of our passengers, our employees, the public and our operating environment is our priority, and the success of our railroad is due to our employees. Are you ready to join our team? Our values of Do the Right Thing, Excel Together and Put...
...Job Summary: ThePlantMaintenance Manager is a key member of the plant leadership team who acts as a technical advisor and is responsible for overall maintenance, repair and/or replacement of plant manufacturing equipment and the overall facility itself. Provides...
...ZGF is seeking a dynamic and well-rounded Mid-Level Interior Architect / Designer to join our team in our Los Angeles office. We are looking for... ...as collaboratively with others toward design solutions Assist in developing design and technical solutions for projects...
Division OverviewAurolife was founded in 2008 as part of a group of companies that has a long history of excelling in generic pharmaceutical product development and manufacturing. Aurolife has a 10 year history of extraordinary manufacturing practices in the solid oral ...