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Certified Ambulance Billing Specialist
2 months ago
Position Overview: This role is essential for ensuring the precise and prompt billing of ambulance services while adhering to established quality and productivity benchmarks. The individual in this position will evaluate diagnoses and service levels based on the information detailed in the Patient Care Report (PCR) and will accurately apply the relevant coding for billing purposes.
Key Responsibilities:
- Conducts a secondary verification of fundamental patient information, including name, address, date of birth, social security number, insurance details, and the hierarchy of insurance related to the service call. Updates information as needed.
- Confirms receipt of and revises PCS information for non-emergency or scheduled trips, or secures preauthorization from payors for the services rendered.
- Reviews and updates service specifics, including pick-up and drop-off locations, date and time of service, type of call, response priority, and transport urgency.
- Assesses medical details to determine the appropriate service code, ICD-10, or condition codes relevant to the patient's complaints.
- Validates and updates the correct billing amount for services provided and procedures performed.
- Identifies the correct procedure codes and modifiers necessary for billing, as dictated by the payor.
- Reports any additional information required for billing accuracy.
- Generates claims for services rendered, either on paper or in the appropriate electronic format, ensuring all necessary details, modifiers, indicators, condition codes, and documentation are included before submission to primary payors.
- Ensures compliance with HIPAA regulations concerning billing practices.
- Maintains a comprehensive record of all trips and claims.
- Confirms that the number of ePCRs received matches the total trips conducted 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 associated medical documentation.
- Engages in continuous cross-training across other functional areas.
Additional Duties: Other responsibilities may be assigned as necessary.
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