Ambulance Claims Billing Manager

Job Description

Job Description

Medical Billing & Claims Manager (Ambulance Operations)

Join Our Team as a Healthcare Claims Expert

We are seeking an experienced Medical Billing & Claims Manager to oversee and manage all aspects of our specialized claims processing, compliance, claim accuracy, denial prevention, and electronic data interchange (EDI) workflows.

While this position focuses on our specialized ambulance claims operations, we welcome high-performing billing and revenue cycle managers from all medical specialties. If you have a masterful understanding of complex payer rules, Medicare guidelines, clearinghouse management, and denial prevention, our team will provide the industry-specific training you need to succeed.

Key Responsibilities

• Claim Optimization: Oversee claim submission activities to ensure maximum first-pass acceptance rates across all payers (Medicare, Medicaid, and commercial insurance).

• Quality Assurance & Auditing: Review claims for accuracy, completeness, and adherence to medical necessity guidelines and documentation standards prior to submission.

• Compliance Monitoring: Stay abreast of changes to CMS regulations, payer policies, and industry guidelines. Ensure compliant utilization of required standard documentation and patient notices.

• EDI & Clearinghouse Management: Troubleshoot electronic claim transmission issues, front-end edits, and payer acceptance errors by analyzing standard ANSI X12 transaction files (837, 277CA, 999).

• Payer Relations: Partner with clearinghouses, software vendors, and insurance intermediaries to resolve electronic claim processing gridlocks.

• Denial Prevention: Analyze rejection and denial trends to implement proactive, systemic corrective actions that improve clean claim rates.

• Team Leadership: Train, mentor, and audit claims staff on compliance standards, authorization processes, and electronic claim submission best practices.

• Cross-Functional Collaboration: Support internal and external audits, ADR requests, and collaborate with clinical and operations teams to optimize documentation quality.

Qualifications

• Experience: Minimum 3 years of healthcare billing management or advanced medical claims experience. Experience in a high-volume, highly regulated billing environment (e.g., hospital, emergency department, or specialized outpatient billing) is highly preferred.

• Regulatory Knowledge: Strong working knowledge of Medicare rules, Medicaid, commercial insurance, and medical necessity requirements.

• Technical EDI Skills: Solid understanding of electronic data interchange (EDI) processes, clearinghouse platforms, and ANSI X12 electronic claim transaction formats.

• Coding & Documentation: Proficiency with healthcare coding systems (HCPCS/ICD-10), modifiers, and interpreting clinical documentation.

• Core Skills: Exceptional analytical, problem-solving, and organizational skills, alongside proficiency in specialized medical billing software.

 

Preferred (But Not Required) Qualifications

• We are fully prepared to train the right candidate on these niche elements:

• Experience specific to ambulance billing regulations, origin/destination coding, or EMS documentation standards.

• Familiarity with Physician Certification Statements (PCS) and Advance Beneficiary Notices (ABNs).

• Experience with repetitive scheduled non-emergency medical transport or specialized prior authorization processes.

• Certified Ambulance Coder (CAC) or related healthcare reimbursement certification.

• Experience preparing documentation for specialized payer audits (ADR, CERT, RAC, UPIC).

Important Scope of the Role

• Focus: This position is strictly dedicated to front-end and mid-cycle claims operations, including claim quality, compliance, documentation review, electronic troubleshooting, clearinghouse management, and denial prevention.

• Exclusions: Responsibilities do not include payment posting, patient collections, traditional accounts receivable management, cash applications, or revenue recovery activities.

 

 

Company Description

Med-Bill Corporation is a Full-Service Ambulance Billing and Compliance Service. Established in 1996, located on the North Side of Indianapolis near Fishers.

Our Certified Staff of Coding, Compliance, Documentation, and Privacy Experts will keep Ambulance Organizations compliant on the State and Federal levels.

We are not like any other billing service; we care about our clients and our patients and do whatever we can to make a difference in our providers' revenue cycle, while also working with the patients on their accounts.

We are not out saving lives like our Providers; however, we can assist in so many other ways by helping on the Billing End!

Company Description

Med-Bill Corporation is a Full-Service Ambulance Billing and Compliance Service. Established in 1996, located on the North Side of Indianapolis near Fishers. \r\n\r\nOur Certified Staff of Coding, Compliance, Documentation, and Privacy Experts will keep Ambulance Organizations compliant on the State and Federal levels.\r\n\r\nWe are not like any other billing service; we care about our clients and our patients and do whatever we can to make a difference in our providers' revenue cycle, while also working with the patients on their accounts.\r\n\r\nWe are not out saving lives like our Providers; however, we can assist in so many other ways by helping on the Billing End!