Billing Specialist - Full Time

CATALDO AMBULANCE BUSINESS TRUST•Somerville, MA

6d•$24 - $30•Onsite

About The Position

The Billing Specialist is a Medical Biller that manages the full revenue cycle for emergency and non-emergency transports. This role is responsible for the maintenance of accurate billing records of complex customer and patient accounts, and communicating with customers to answer questions or provide information as needed. The position requires accurately submitting claims to Medicare, Medicaid, commercial insurers, handling claim denial management, verifying coverage, and auditing Emergency Medical Service (EMS) Transports to ensure proper CMS compliance. This position requires a blend of healthcare administration, financial tracking, and billing software proficiency.

Requirements

High school diploma or GED equivalent is required.
Minimum 2 years of Medical Billing experience.
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.
Comply with UDS drug screening at any and all times.
Completion and receipt of satisfactory background check and MA CORI (Criminal Offender Record Information), verification may be required annually.

Nice To Haves

Post-secondary certification in medical billing or coding (CAC, CPB from AAPC or other) highly preferred.
Prior experience in EMS, Ambulance, transportation medical billing preferred.
Knowledge of international payment and invoicing process a plus.

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.
Contacting 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 submitting 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 adhering 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.
Consistently meets and maintains productivity goals and defined benchmarks on a weekly basis.
Additional projects and responsibilities as assigned and requested.
Maintains knowledge of and complies with all company policies, procedures, and guidelines at all times.