Brooklyn Senior Biller

Donald Martens & Sons Ambulance Services•Cleveland, OH

About The Position

The Senior Billing Representative has at least three years’ experience and a demonstrated record of high-quality and high-volume billing. This incumbent is responsible for accurate coding and follow-up on insurance claims and resolve unpaid accounts in a timely and efficient manner while maintaining the minimum production standards set by the Billing Manager.

Requirements

At least three years’ experience
Demonstrated record of high-quality and high-volume billing
Strong professional communication skills.
Work in a spirit of teamwork and cooperation.
Convey a sense of competence and commitment.
Use initiative to learn new skills, enhance personal knowledge and improve communications
Demonstrate the ability to work well with team members.
Communicate a willingness to help others succeed.
Share workspace and resources as necessary.
Medical transportation processes.
Understanding of the terminology of a PCR, Hospital Face Sheet, and or a CAD sheet.
Understanding of the distinctions between the different level of service (e.g. ALS, BLS, Wheelchair, SCT, and CCT).
Understanding of the distinctions between the different level of service (e.g. ALS, BLS, Wheelchair, SCT, and CCT).
Understanding of insurance carrier coverage guidelines, filing limits, and necessary prior authorizations.
HIPAA requirements.
Flexible with shifting daily priorities.
Meet deadlines working within tight time constraints.
Handle large volume of work and or telephone calls.
Recognize improper fee schedules.
Identify non-payment issues by carrier, claim, and to escalate to Management as necessary.
Recognize overpayments and request refunds as necessary.
Prioritize workflow.
Process clean claims.
Exceed minimum quality performance standards consecutively for a minim of six months, and maintain those standards for a minimum of four out of every six-month rolling time-period.
Ability to meet, exceeds, or sustains established standards for productivity.
Ability to communicate effectively, both orally and in writing, in English.
High Scholl Diploma or GED required
A minimum of three (3) years billing experience with Medicare and other insurances in the healthcare industry (preferably in medical transportation).

Nice To Haves

Associates Degree or Technical Certification in Coding and Billing preferred.

Responsibilities

Process claims within an appropriate timeframe (e.g. claim status check, appeals of denied claims).
Recode insurance claims into the Accounts Receivable Billing System as necessary.
Update appropriate modifiers based on origin and destination of the trip and change insurance claims as necessary.
Create narrative in the Accounts Receivable Billing System to document status of trip for use in claim appeals.
Ensure charges are billable to a particular insurance based on the payer’s criteria (e.g. prior authorization) as needed.
Resolve payment issues with carrier (e.g. denials partial payments, etc.).
Refile and appeal claims as necessary.
Process incoming correspondence, including signatures letters, denials, and additional information necessary to release the claim.
Review clearinghouse transmission listings and carrier acknowledgment reports to make appropriate corrections as required.
Determine the appropriate level of service to be billed based on supporting documentation on the PCR and or in the CAD notes, including but not limited to, designating Advanced Life Support (ALS), Basic Life Support (BLS), Wheelchair, Specialty Care Transport (SCT), or Critical Care Transport (CCT).
Assign appropriate condition code/ICD-10 codes into the Accounts Receivable Billing System.
Accept incoming calls from carriers, providers, and patients.
Ensure all Medicare billing requirements are met. (Certificates of Medical Necessity, Signatures etc.).
Identify patterns of concern in medical documentation that may affect payment of claim. (Medical Necessity calls to providers, Clinical Documentation Improvement forms for crew members).
Complete Ambulance Certification for all Medicare claims.
Verify eligibility of benefits via internet and or telephone.
Escalate the appeal process as needed.
Proactively update skills and knowledge on billing regulations and practices
Responsible for assisting with training peers to ensure understanding of the current processes and billing practices.
Demonstrate billing subject matter knowledge at an expert level to encourage and assist in development of peers.
Accept and complete interim assignments in a timely manner.
Manage own time and work assignments effectively.
Seek advice/feedback in terms of priorities or issues when necessary.
Perform other duties as assigned and required.