Billing Specialist - Full Time
$49,920,000–$62,400,000 year
On-siteSomerville, Massachusetts, United States
Job Summary
Manage the full revenue cycle for emergency and non-emergency transports by accurately submitting claims to Medicare, Medicaid, and commercial insurers while handling denial management and verifying coverage. Review Patient Care Reports and Physician Certification Statements to determine appropriate billing levels and ICD/HCPCS codes, then contact healthcare providers and insurance providers to secure prior authorizations and obtain necessary documentation. Enter complete patient and trip information into the billing system, post insurance reimbursements, reconcile accounts, and process refunds. Address customer service inquiries, explain billing processes, and establish payment plans while ensuring all activities strictly adhere to federal, state, and HIPAA regulations. Collaborate with dispatch to ensure trips are financially cleared in a timely manner.
Required Qualifications
- High school diploma or GED equivalent
- Post-secondary certification in medical billing or coding (CAC, CPB from AAPC or other)
- Minimum 2 years of Medical Billing experience
- Prior experience in EMS, Ambulance, transportation medical billing
- Knowledge of HIPAA and Healthcare standards
- Knowledge of medical terminology, CPT/HCPCS codes, and ICD-10 coding
- Knowledge and understanding of insurance coverages, fee schedules and regulations, Medicaid and Medicare Ambulance Guidelines, and private insurance reimbursement protocols
- Knowledge of international payment and invoicing process
- Proficiency with medical billing software, electronic health records (HER) systems
- Working knowledge of Web based applications and Microsoft Office, including Excel and Word
- Ability to communicate effectively, both verbally and in writing
- Ability to understand and carry out verbal and written instructions
- Analytical skills to gather and interpret data
- Ability to exercise sound judgment and discretion at all times
- Strong interpersonal skills, resolving issues quickly and efficiently
- Excellent organization skills: attention to detail and follow-through
- Ability to multitask, take charge and ownership of tasks
- Ability to work independently and in a team setting
- Ability to handle highly confidential information with complete discretion
- Ability to work in a fast paced, high demand environment
- 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
- Close vision, peripheral vision, depth perception, and ability to adjust focus to read computer screens and printed documents
- Ability to hear and understand speech in person and on the telephone
- Ability to communicate clearly in person and via phone
- High level of finger dexterity to operate computers, calculators, and office machinery
- Ability to lift, carry, or move documents, files, or office equipment (typically up to 10-25 pounds)
- Exceptional organizational and time-management skills to handle daily tasks
- Ability to input data accurately and read fine statistical reports
- Ability to manage deadlines and resolve issues
Desired Qualifications
- Post-secondary certification in medical billing or coding (CAC, CPB from AAPC or other)
- Prior experience in EMS, Ambulance, transportation medical billing
- Knowledge of international payment and invoicing process
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