The Facility Coding Representative is responsible for the accurate and timely coding of ambulance transports, while maintaining the minimum quality and productivity standards set for the Initial Billing Team (IBT). The Facility Coding Representative is expected to determine and bill the correct payer responsible for the transport and assign appropriate diagnosis codes, modifiers, and levels of service based on the documentation received from the EMS providers.
- Determine the Level of Service to be billed based on supporting documentation within the medical record, including but not limited to, designating Advanced Life Support (ALS), Basic Life Support (BLS), Wheelchair, or Specialty Care Transport (SCT)/Critical Care Transport (CCT).
- Ensure that charges are billable to a facility based on the payer’s criteria. Assign ancillary procedures to charges when applicable (e.g. IV treatment and oxygen). Assign appropriate modifiers, based on origin and destination of trip and/or payer requirements.
- Identify when a transport is a paramedic intercept, mandate, other special billing situation and direct to the appropriate carrier or bill to the facility.
- Identify quoted rates and/or credit card payments as specified in PCR and/or CAD notes and bill accordingly.
- Verify coverage eligibility via Internet or by telephone and update/add insurance or contract coverage to the Accounts Receivable Billing System. Review and/or determine the appropriate primary source of payment.
- Adhere to all local, state and federal compliance rules and regulations.
- Partner with multiple levels of management and departments to maximize the efficiency of the billing process and accuracy of claims adjudication. Work in a spirit of teamwork and cooperation.
- Identify pertinent information from data on reports or other documents. Review and correct, as necessary.
- High School Diploma or GED required.
- One (1) year of medical billing experience preferred; medical transportation billing experience a plus.
- Communicate effectively, both orally and writing, in English.
- Ability to effectively utilize proprietary accounts receivable billing system and internet tools, (e.g., internet mapping programs, eligibility websites, address search engines).
- Knowledge of HIPAA requirements, Sarbanes-Oxley (SOX) requirements, PHI, and compliance regulations.
- Required skills: Microsoft Outlook, Excel, Word.
Integra Connect, LLC provides a comprehensive benefits plan.
- Medical/Dental/Vision Insurance beginning the 1st of the month following your date of hire
- Paid Time Off
- 401k with employer match
- Paid Holidays and Floating Holiday
Equal Opportunity Employer
|Job Category||Billing Administration|