EMS Billing & Documentation Specialist
hace 23 horas
La Mesa
Express Ambulance Location: Lemon Grove, CA 91945 Department: Billing & Compliance Job Type: Full-Time | In-Person FLSA Status: Non-Exempt Reports To: Billing Supervisor / Management ABOUT EXPRESS AMBULANCE Express Ambulance is a growing EMS organization serving the San Diego community. We are committed to dependable, professional, and compassionate medical transportation while maintaining high standards for documentation, compliance, and reimbursement. We are seeking an experienced EMS Billing & Documentation Specialist with a strong understanding of ambulance and medical transportation billing. This is not an entry-level medical billing position. We are looking for a knowledgeable, dependable professional who can recognize documentation deficiencies, understand ambulance billing requirements, communicate effectively with field and administrative personnel, and help ensure claims are complete and accurate before submission. POSITION SUMMARY The EMS Billing & Documentation Specialist serves as a key link between field operations, dispatch, healthcare facilities, and billing. Responsibilities include reviewing Patient Care Reports (PCRs), reconciling transports with dispatch records, identifying and resolving documentation deficiencies, obtaining supporting documentation, verifying patient and insurance information, and preparing accurate accounts for billing. The ideal candidate has direct experience with ambulance, EMS, NEMT, medical transportation, or related medical billing and understands medical necessity, level of service, mileage, signatures, authorizations, insurance requirements, and supporting documentation. ESSENTIAL DUTIES & RESPONSIBILITIES-EMS Documentation & PCR Review • Review ePCRs for completeness, accuracy, consistency, and billing readiness., • Review narratives, assessments, signatures, mileage, transport details, origin/destination, and supporting documentation., • Identify incomplete, conflicting, or insufficient documentation., • Review documentation for support of medical necessity and level of service., • Communicate deficiencies to appropriate personnel and follow through until resolved.-Call & Transport Reconciliation, • Reconcile dispatch/CAD records with completed PCRs., • Identify missing PCRs, duplicate records, incomplete calls, cancellations, refusals, standbys, and other discrepancies., • Ensure transported and non-transported calls are appropriately documented., • Investigate discrepancies between CAD, PCR, facility, and billing records.-Supporting Documentation Obtain and organize documentation needed to support ambulance claims, including: • Physician Certification Statements (PCS), • Hospital/facility face sheets, • Patient demographics and insurance information, • Medical records and supporting facility documentation, • Authorizations and required signatures, • Other documentation supporting medical necessity or claim processing Communicate professionally with hospitals, skilled nursing facilities, dialysis centers, physician offices, case managers, and other healthcare partners to obtain missing information and ensure timely follow-up. -Insurance & Eligibility Verification • Verify patient demographics and insurance information., • Review Medicare, Medi-Cal/Medicaid, managed care, and commercial insurance., • Verify eligibility and benefits through payer portals and systems., • Identify authorization or additional documentation requirements., • Correct demographic and administrative information when appropriate.-Billing Quality Assurance, • Prepare complete and accurate accounts for coding, claims submission, or the next stage of the revenue cycle., • Identify issues that may cause claim delays, denials, or reimbursement problems., • Maintain records of missing documentation and outstanding accounts., • Assist with researching rejected or problematic accounts., • Identify recurring documentation issues and escalate trends to management., • Help improve documentation quality and clean-claim readiness.-Operations & Dispatch Collaboration, • Work closely with dispatch and field operations regarding transport documentation., • Assist with documentation requirements for scheduled and repetitive transports., • Communicate deficiencies professionally with EMTs, dispatchers, supervisors, and management., • Provide feedback regarding recurring documentation errors., • Serve as an administrative resource for ambulance documentation and pre-billing requirements.-Compliance & Confidentiality, • Handle protected health information in accordance with HIPAA and company policies., • Maintain accurate, organized, and auditable records., • Follow billing, compliance, and documentation procedures., • Escalate potential compliance concerns to leadership., • Maintain strict confidentiality. REQUIRED QUALIFICATIONS • High school diploma or equivalent., • Previous ambulance, EMS, medical transportation, NEMT, or closely related medical billing experience., • Working knowledge of medical billing and reimbursement., • Experience reviewing clinical or transport documentation for billing., • Understanding of insurance eligibility and verification., • Familiarity with Medicare, Medicaid/Medi-Cal, managed care, and commercial insurance., • Familiarity with ambulance medical necessity and supporting documentation., • Experience with ePCR systems, billing software, payer portals, EMRs, or similar healthcare technology., • Strong computer and data-entry skills., • Excellent written and verbal communication., • Exceptional attention to detail and organization., • Ability to independently investigate missing or conflicting information., • Ability to manage a high volume of accounts accurately., • Consistent and reliable attendance. HIGHLY PREFERRED EXPERIENCE Direct experience with: • Ambulance billing and reimbursement, • Medicare, Medi-Cal, and commercial ambulance claims, • BLS and ALS ambulance billing, • Non-emergency and repetitive patient transportation, • Physician Certification Statements (PCS), • Medical necessity documentation, • Prior authorizations, • ePCR review and correction, • CAD-to-PCR reconciliation, • Eligibility verification, • Clean-claim preparation, • Claim rejection or denial research, • EMS billing software, • ImageTrend, EMSCharts, or comparable ePCR platforms, • Experience working with ambulance crews, dispatch centers, hospitals, skilled nursing facilities, dialysis centers, or other healthcare facilities is highly valued. WHO WE'RE LOOKING FOR We want someone who understands that successful EMS billing begins before a claim is submitted. The right candidate does more than identify missing information. They investigate the account, determine what is needed, obtain the appropriate documentation, communicate with the necessary parties, and follow the issue through resolution. Our ideal candidate is experienced, detail-oriented, reliable, organized, proactive, professional, and accountable. They are comfortable managing multiple accounts and deadlines, communicating documentation requirements, working independently, and identifying documentation that does not adequately support the service being billed. WHY JOIN EXPRESS AMBULANCE? Express Ambulance is continuing to grow, and we are looking for experienced professionals who want to grow with us. This position offers exposure to both the operational and financial sides of EMS. Strong employees may have opportunities to expand their knowledge, take on additional responsibility, and contribute to improving company processes. We value reliability, initiative, professionalism, accountability, and consistently strong performance. BENEFITS Full-time employees may be eligible for: • Medical, dental, and vision insurance, • Paid sick leave, • Consistent full-time schedule, • Professional development and growth opportunities, • Valuable ambulance revenue-cycle experience SCHEDULE & WORK LOCATION This is a full-time, in-person position in Lemon Grove, CA 91945. Regular and dependable attendance is required. EQUAL EMPLOYMENT OPPORTUNITY Express Ambulance is an Equal Opportunity Employer. Employment decisions are made without regard to any characteristic protected by applicable federal, state, or local law.
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