EMS Medical Coding Specialist

Paramedic Services of Illinois•Itasca, IL

6d•$26 - $32•Hybrid

About The Position

The EMS Medical Coding Specialist is responsible for accurate and compliant assignment of diagnosis and procedure codes to emergency medical services encounters, including ground and air ambulance transports. This senior-level position requires expert knowledge of ICD-10-CM, HCPCS Level II coding conventions, and Medicare/Medicaid billing regulations specific to EMS transport services. The specialist ensures optimal reimbursement while maintaining strict adherence to federal and state compliance requirements.

Requirements

Minimum 3–5 years of EMS/ambulance medical coding experience.
Active CPC, CCS, or COC credential from AAPC or AHIMA; CPC-P or AMPA EMT-Coder preferred.
Expert-level knowledge of ICD-10-CM, HCPCS Level II, and CMS ambulance billing rules.
Demonstrated experience with Medicare ambulance billing, including ABN requirements and transport certification statements.
Proficiency with EMS billing software (e.g., Zoll Billing, TriTech, ESO, ImageTrend).
Strong understanding of federal and state ambulance reimbursement regulations.
High school diploma or GED required

Nice To Haves

Associate's or Bachelor's degree in Health Information Management preferred.
Certified Ambulance Coder (CAC), Certified Professional Coder (CPC), or other revenue cycle certification.
Familiarity with value-based care models and ET3 (Emergency Triage, Treat, and Transport) program billing.
Knowledge of state-specific Medicaid managed care ambulance reimbursement policies.
Experience with revenue cycle analytics and reporting tools.

Responsibilities

Review and abstract patient care reports (PCRs) to assign accurate ICD-10-CM diagnosis codes and HCPCS transport codes (A0426–A0436).
Evaluate medical necessity documentation to support BLS, ALS-1, ALS-2, and specialty care transport (SCT) levels.
Apply modifiers (e.g., QL, QM, QN) correctly for Medicare and Medicaid claims.
Query EMS providers for incomplete or ambiguous clinical documentation in accordance with AHIMA query guidelines.
Maintain coding accuracy rate of 95% or above on internal and external audits.
Submit clean claims to Medicare, Medicaid, and commercial payers following payer-specific guidelines.
Review and resolve coding-related claim denials, underpayments, and appeals.
Identify and escalate patterns of denial or documentation deficiency to management.
Coordinate with billing staff to ensure seamless claims submission and follow-up.
Ensure coding practices comply with OIG guidelines, HIPAA, and payer-specific policies.
Participate in internal audits and respond to external audit requests.
Monitor and implement updates related to annual HCPCS/ICD-10 code changes and CMS rulemaking.
Maintain current knowledge of Local Coverage Determinations (LCDs) for ambulance services.