SUMMARY: This position is responsible for the accurate and timely billing of ambulance transports while maintaining quality and productivity standards. This position is expected to determine diagnosis and levels of service, based on information provided on the Patient Care Report (PCR) and to accurately bill using the appropriate codes.
ESSENTIAL DUTIES AND RESPONSIBILITIES: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
•Reviews as a second verification basic information for the patient, including name, address, date of birth, social security number, insurance information, ranking of insurance related to call. Update as necessary.
•Verifies receipt of and update PCS information (if non emergency and/or schedule trips) or payor’s preauthorization of services for the trip.
•Verifies and updates service details, including pick-up and drop-off addresses, date and time, call type, response priority and transport priority.
•Verifies the medical details and determine the appropriate service code, ICD-9 or condition codes for the patient’s complaint(s).
•Verifies and updates the correct amount to charge for the services rendered, and the procedures administered.
•Determines the correct procedure codes and modifiers you must use for the charges, as required by the payor being billed.
•Reports any additional information needed such as diagnoses to Team Lead.
•Generates a claim for the trip—on paper or in the correct electronic submission format-that includes all the necessary details, modifiers, indicators, condition codes, and documentation, and send to the primary payor(s).
•Assure HIPAA compliance with regard to billing practices.
•Keeps track of all trips and claims.
•Ensures tickets received is equal to the total trips for that day by reviewing receipts of email from DIVA in conjunction with scanned tickets received on shared drive or paper tickets received.
•Stays abreast of all coding regulations, particularly as it relates to assigned state or payor.
•Maintains files for all trips and medical documentation.
•Continuously cross-trains in other function areas.
•Other duties as assigned.
KNOWLEDGE, SKILLS & ABILITIES
•Thorough knowledge of ambulance transport documentation.
•Extensive knowledge of ICD-9 and Condition Codes.
•Ability to collect for healthcare claims from MCR/MCD, commercial insurance, contracted facilities, and individuals.
•Understands Medicare and Medicaid regulations and guidelines.
•Familiarity with Medicare, Medicaid, Coding, Private Pay, and insurance preferred.
•Familiarity with medical terminology.
•Ability to interpret EOB (Explanation of Benefits)
•Familiarity with Microsoft Office Suite
•Working knowledge of RightCAD database
EDUCATION AND RELATED WORK EXPERIENCE
•High school diploma or general education degree (GED)
•Minimum of 1-year medical billing experience with a high volume practice or clinic, ambulance experience preferred.
•Combination of education and experience considered.
LICENSES, REGISTRATIONS or CERTIFICATIONS
•Ambulance/Medical billing certification or diploma preferred.
An Equal Opportunity/Affirmative Action Employer - M/F/Veteran/Disability
Lifeguard Ambulance Service wants all interested and qualified candidates to apply for employment opportunities. If you are a U.S. applicant with a disability who is unable to use our online tools to search and apply for jobs, please contact us at 866-938-0160 or email firstname.lastname@example.org. Please indicate the specifics of the assistance needed. This option is reserved only for individuals with disabilities that are unable to use the online tools and is not intended for other purposes.