Sr Medicare Biller
1 day ago
Yonkers
Position Summary The Senior Medicare Biller is responsible for overseeing and managing Medicare billing processes for ambulance transports in compliance with federal, state, and payer-specific regulations. This role requires advanced knowledge of Medicare ambulance billing, New York State Medicaid coordination, documentation requirements, and appeals processes. The Senior Medicare Biller serves as a subject matter expert and ensures timely and accurate reimbursement while maintaining compliance with all regulatory standards. Key Responsibilities • Process, review, and submit Medicare claims for emergency and non-emergency ambulance services in accordance with CMS and New York State regulations, • Ensure accurate coding, modifiers, mileage, and level-of-service billing (BLS, ALS1, ALS2, SCT), • Review documentation for medical necessity, physician certification statements (PCS), trip reports, and supporting records, • Identify, research, and resolve Medicare denials, underpayments, and rejections, • Prepare and submit redetermination, reconsiderations, and higher-level appeals as needed, • Coordinate Medicare crossover claims to New York State Medicaid and other secondary insurers, • Maintain compliance with CMS guidelines, OIG standards, HIPAA, and company policies, • Monitor aging reports, follow up on unpaid or delayed claims, and ensure timely resolution, • Act as a resource and mentor to billing staff, providing training and guidance on Medicare-related issues, • Assist with audits, compliance reviews, and internal quality assurance initiatives, • Communicate effectively with Medicare Administrative Contractors (MACs), Medicaid, and internal departments, • Stay current on Medicare policy updates, fee schedule changes, and regulatory requirements Qualifications, • Minimum of 3-5 years of Medicare ambulance billing experience required, • In-depth knowledge of CMS ambulance billing regulations and New York State billing practices, • Strong understanding of medical necessity requirements and documentation standards, • Experience with Medicare appeals and denial resolution, • Proficiency with ambulance billing software and electronic claim submission systems, • High attention to detail and strong analytical skills, • Ability to prioritize workload and meet deadlines in a fast-paced environment, • Excellent written and verbal communication skills, • Ability to maintain confidentiality and compliance with HIPAA regulations Preferred Qualifications, • Experience with New York State Medicaid, No-Fault, and Workers' Compensation coordination, • Prior supervisory or lead billing experience, • Familiarity with compliance audits and payer reviews, • CAC, CPC, CPB, or other relevant billing/coding certification Work Environment, • Office-based or hybrid role depending on company needs, • Fast-paced EMS billing environment with high-volume claim processing