Responsible for verifying insurance and demographics of medical transport patients and obtain authorizations, if necessary, to ensure that all information is correct for billing.
- Verifies insurance to ensure patient is covered and insurance information is accurate; uses websites or calls to payors as available.
- Ranks insurance in correct order by determining primary, secondary, or tertiary insurance.
- Responsible for obtaining all pre-authorizations for ambulance and/or wheelchair transportation as required.
- Stays current with all payor requirements for pre-authorizations.
- Maintains and ensures all documentation is received (i.e. medical necessity forms) and insurance verified monthly on all repetitive patients.
- Coordinates with Operations for onsite evaluations for dialysis patients.
- Maintains a log for review of repetitive patients to ensure PCS is within required span of time – within 60 days from date signed.
- If forms are not obtained or incomplete, moves account to Incomplete Schedule.
- Works the Incomplete workflow to secure necessary paperwork. Contacts those who issue medical necessity forms directly. If an issue exists, notifies and works with assigned Marketer after notifying Operational Manager.
- Provides Patient Call Reports (PCRs) to Coding Specialists by 2 p.m. daily.
- Acts as a Billing resource to marketing and operational staff regarding medical necessity of transports.
- Obtains payment information prior to transport for all transports not medically necessary as defined by CMS, Ambulance Provisions, Chapter 10.
- If co-pay is greater than $100, collects before transport.
- If distance is greater than 50 miles, collects before transport.
- For any requested transport in which a patient does not have insurance coverage, appropriate medical necessity forms, or payment as outlined above, Operations Manager must be notified before transport takes place.
- Maintain HIPAA compliance with regard to billing practices.
- Creates and maintains a strong team environment through communication, motivation, and consistency.
- Performs special projects for upper management.
- Plans and manages multiple projects.
- Continuously cross-train in other function areas.
- Other duties as assigned.
- High school diploma or general education degree (GED)
- Minimum of 2-years medical billing experience with a high volume practice or clinic, ambulance experience
- Combination of education and experience
- Ambulance/Medical billing certification or diploma
- Thorough knowledge of ambulance transport
- Extensive knowledge of ICD-9 and Condition Codes.
- Ability to collect for healthcare claims from MCR/MCD, commercial insurance, contracted facilities, and
- Understands Medicare and Medicaid regulations and
- Familiarity with Medicare, Medicaid, Coding, Private Pay, and insurance
- Familiarity with medical
- Ability to interpret EOB (Explanation of Benefits)
- Familiarity with Microsoft Office Suite
- Working knowledge of RightCAD database.
Integra Connect, LLC provides a comprehensive benefits plan.
- Medical/Dental/Vision Insurance beginning the 1st of the month following your date of hire
• 401k with employer match
• Paid Time Off
• Paid Holidays and Floating Holiday
Equal Opportunity Employer
|Job Category||Revenue Management|