Medicare Biller

Hourly Wage Range $30.00 - $35.00 an hour

Enrollment and Billing Specialist 

SUMMARY

Must have a minimum 5-year experience with a strong knowledge of Medicare billing guidelines and regulations. Must ensure the timely and accurate billing of ambulance transports through pre-billing &  routine audits.

MAJOR DUTIES & RESPONSIBILITIES

• Responsible for accurate billing process under the direct and indirect supervision of Revenue Manager.
• Review patient care reports thoroughly, utilizing all available documentation in order to establish medical necessity, selection of levels of service, origin/destination modifiers and patient condition at the of transport.
• Accurately assign condition codes to support reason for transport.
• Must meet daily established Billing productivity goal.
• Responsible for escalating documentation that does not meet billing guidelines to appropriate management.
• Ability to train other teammates on compliance & Medicare guidelines.
• Measure compliance and accuracy through routine prebilling and post payment reviews and audits.
• Demonstrates continuous effort to improve operations, decrease turnaround times, streamline work processes and work cooperatively and jointly to provide quality work
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Other duties may be assigned.

SUPERVISION: Reports to Revenue Manager

JOB TYPE: FULL TIME

QUALIFICATIONS/ REQUIREMENTS:

• Certified Ambulance Coder (CAC) or Certified Professional Coder (CPC) preferred
• Extensive Medicare and Medicaid experience and understanding medical necessity in ambulance transportation
• Ambulance/Medical billing certification or diploma preferred
• Maintain working knowledge of ICD-10, CPT and HCPCS coding.
• Excellent organizational skills and the ability to multi-task in a fast-paced environment
• Review and research data; use intuition and experience to complement data
• Thorough knowledge of transport documentation (PCRs)
• Ability to follow up on outstanding Medicare accounts
• Ability able to submit appeals and overpayment requests
• Familiar with Medicare/CMS requirements and guidelines.
• Health Insurance Portability and Accountability Act (HIPAA) requirements and record retention compliance.
• Excellent written and verbal communications skills required · Excellent documentation skills (promptness, accuracy, thoroughness, and legibility)

EDUCATION:  High School diploma or equivalent required.

EXPERIENCE:

• Five years of medical terminology, ICD-9 coding, and automated patient accounting systems and/or electronic billing systems preferred.
• Documentation of completion of requisite Medicare/Medicaid update courses and industry courses.

CERTIFICATION AND LICENSURE:  

• Certified Ambulance Coder (CAC) or Certified Professional Coder (CPC) preferred

SKILLS:

• Working knowledge of EMS systems/private ambulance and medical transportation systems preferred;
• Computer proficiency preferred
• Knowledge of CONNEX preferred

• Knowledge Microsoft Word, Microsoft Excel, and Microsoft Windows.
• Familiarity with medical terminology
• Organizational and leadership abilities, detail oriented

PERFORMANCE BENCHMARK:

• Meets established daily billing productivity goals.

PHYSICAL REQUIREMENTS:

• High level of sitting/working at desk.
• Light physical effort (lift/carry up to 20 lb.)

ENVIRONMENTAL CONDITIONS:

• Work is performed under basically normal working conditions, as in a standard office environment.