Ambulance Billing Specialist

Ambulance Billing Specialist The primary focus of this role is to perform comprehensive insurance verification to confirm active coverage and benefits, initiate and track prior authorization requests through various payer portals. Key Responsibilities Insurance Verification: Verify patient insurance eligibility and ensure all documentation meets medical necessity and regulatory standards. Prior Authorization: Submit and track authorization requests for non-emergency medical transports (NEMT) and facility-to-facility transfers via insurance portals, fax, or phone. Medical Necessity Review: Analyze patient care reports and Physician Certification Statements (PCS) to ensure they meet specific payer criteria for the requested level of transport. Documentation Management: Scanning medical records, managing digital attachments, and ensuring all physical documentation is accurately uploaded into the billing system. Required Qualifications Experience: 1–2 years of experience in revenue cycle is required. Previous experience in EMS billing is highly preferred. Technical Knowledge: Proficiency in CPT, ICD-10, and HCPCS coding, along with a deep understanding of government and commercial payer regulations. Software Skills: Proficiency in Microsoft Office (Word, Excel) and strong typing skills. Education: High school diploma or equivalent required. Core Competencies Time Management: Capable of handling high-volume requests with tight deadlines. Detail Oriented: High level of accuracy in verifying policy numbers and effective dates to prevent downstream denials. Communication: Proven ability to maintain professional composure and high productivity during extended insurance hold times, utilizing verbal de-escalation and persuasive communication to resolve claim denials efficiently. #J-18808-Ljbffr Lifelineamb