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Ambulance Billing and Coding Specialist
2 months ago
Position Overview: This role is essential for ensuring precise and prompt billing for ambulance services while adhering to quality and efficiency benchmarks. The individual in this position will assess diagnoses and service levels based on details from the Patient Care Report (PCR) and will apply the correct coding for billing purposes.
Key Responsibilities:
- Conducts a thorough review of essential patient information, including personal details and insurance specifics, making updates as required.
- Confirms receipt of and updates Patient Care Service (PCS) data for non-emergency or scheduled trips, including necessary preauthorizations from payors.
- Validates service particulars such as pick-up and drop-off locations, date and time of service, type of call, and response priority.
- Assesses medical information to identify the appropriate service codes, ICD-10, or condition codes relevant to the patient's issues.
- Determines the correct billing amounts for services provided and procedures performed.
- Identifies the necessary procedure codes and modifiers for billing in accordance with payor requirements.
- Reports any additional information that may be required for claims processing.
- Prepares claims for services rendered, ensuring all details, modifiers, indicators, condition codes, and documentation are included, and submits them to the primary payors.
- Ensures compliance with HIPAA regulations concerning billing practices.
- Maintains accurate records of all trips and claims.
- Verifies that the number of electronic Patient Care Reports (ePCRs) matches the total trips for the day.
- Stays informed about all coding regulations, particularly those applicable to the assigned state or payor.
- Maintains organized files for all trips and medical documentation.
- Engages in continuous cross-training across various functional areas.
Additional Duties: Other responsibilities may be assigned as needed.
