Auditing, Billing, Centers for Medicare and Medicaid Services (CMS), Data Entry, Demographics, Health Insurance, ICD-10, Insurance, Legal Documents, Medicaid, Medical Billing, Medical Records, Medicare, Multitasking, Organizational Skills, Patient Care, Problem Solving Skills, Regulations, Slack, Systems Maintenance, User Interface/Experience (UI/UX)
What You’ll Do (Key Responsibilities)
Clinical Coding & Charge Entry (35% of your time)
- Assign and sequence appropriate ICD-10-CM diagnosis codes and CPT/HCPCS procedure codes based on clinical documentation.
- Translate patient transport data into billable charges, ensuring that the level of service billed perfectly matches the medical necessity documented in the Electronic Patient Care Report (ePCR).
- Maintain a sharp, up-to-date understanding of coding bundling, modifiers, and global periods to proactively prevent claim denials.
Demographic & Insurance Verification (25% of your time)
- Conduct comprehensive audits of patient information, including legal name, address, date of birth, and guarantor details for every claim.
- Verify insurance eligibility and primary/secondary/tertiary coverage using clearinghouses and payer portals.
- Ensure all insurance details are entered flawlessly to minimize "front-end" rejections.
Documentation Compliance & "Send Backs" (20% of your time)
- Review ePCRs for signature compliance and missing clinical documentation.
- Identify and flag incomplete records, preparing "send back" tasks for clinical staff or providers to ensure documentation meets legal and billing guidelines.
- Monitor the "Send Back" queue to ensure corrections are returned and processed quickly.
Claims Resolution & Rebilling (15% of your time)
- Research and resolve basic claim edits or denials related to coding or demographic discrepancies.
- Update account notes to accurately reflect the status of rebilled claims and any actions taken to resolve payment delays.
Systems Maintenance & Team Collaboration (5% of your time)
- Perform critical data corrections within HealthEMS and other ePCR programs.
- Coordinate with providers, clients, and internal colleagues via email and Slack to resolve billing hurdles.
- Stay current on company processes and industry regulatory updates by actively participating in department meetings.
What We’re Looking For
Experience:
- At least 3 years of experience with Medical Insurance.
Knowledge, Skills, & Abilities:
- Technical Knowledge: Proficiency in ICD-10-CM coding; familiarity with CMS (Medicare/Medicaid) billing rules, private payer regulations, and medical necessity for emergency/non-emergency transport.
- Core Skills: High-speed, high-accuracy data entry; advanced problem-solving; professional written communication; ability to interpret complex medical narratives.
- Key Abilities: A strong ability to maintain deep focus and accuracy during repetitive tasks, and the organizational skill to manage multiple "queues" or task lists simultaneously.
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Emergent Health Partners