Remote Ambulance Coder

Job Title: Remote Ambulance Coder Work Location: Pafford Medical Services, Inc. - Oklahoma City Division/Department: PMBS Reports To: Coding Supervisor Full-Time Nonexempt The Ambulance Coder is responsible for reviewing ambulance patient care reports (PCRs) and accurately assigning diagnosis, procedure, level-of-service, and other required billing codes based on the clinical documentation provided. This position evaluates the patient's condition, services rendered, medical necessity, origin and destination, and transport circumstances to support accurate and compliant ambulance billing. The Ambulance Coder applies Medicare, Medicaid, commercial payer, and other applicable regulatory requirements when determining the appropriate level of service and coding for ambulance transports. Essential Duties And Responsibilities Review ambulance patient care reports and supporting medical documentation for completeness and coding accuracy. Interpret clinical documentation, including the patient's condition, symptoms, assessment findings, interventions, medications, monitoring, and response to treatment. Determine the appropriate ambulance level of service based on the patient's condition and documented services provided. Assign accurate ICD-10-CM diagnosis codes based on the condition chiefly responsible for the ambulance transport and other relevant documented conditions. Assign appropriate HCPCS ambulance codes, including BLS, ALS1, ALS2, Specialty Care Transport (SCT), and other applicable ambulance services. Apply appropriate ambulance modifiers based on the documented origin and destination. Review documentation to determine whether the transport meets applicable medical necessity requirements. Evaluate documentation supporting emergency and non-emergency ambulance transportation. Identify documentation deficiencies, inconsistencies, or missing information that may affect coding, medical necessity, or reimbursement. Refer documentation requiring clarification or additional review through the appropriate clinical or coding process. Validate mileage, supplies, procedures, medications, and other billable services when applicable. Apply Medicare, Medicaid, and payer-specific ambulance coverage and coding requirements. Maintain compliance with CMS regulations, HIPAA requirements, organizational policies, and applicable federal and state regulations. Remain current on changes to ICD-10-CM, HCPCS, Medicare ambulance regulations, payer policies, and industry coding guidance. Participate in coding audits, education, and quality-improvement activities. Meet established productivity and accuracy standards while maintaining coding quality and compliance. Work collaboratively with billing, clinical documentation, compliance, operations, and revenue cycle staff to resolve coding and documentation issues. Minimum Qualifications Strong understanding of medical terminology, anatomy, physiology, disease processes, and emergency medical services. Knowledge of ICD-10-CM and HCPCS coding principles. Knowledge of ambulance levels of service, including BLS, ALS1, ALS2, and SCT. Ability to interpret EMS clinical documentation and identify the patient's primary reason for transport. Understanding of ambulance medical necessity and coverage requirements. Ability to distinguish between the services available, services performed, and services required by the patient's condition when determining the appropriate level of service. Strong analytical skills and attention to detail. Ability to recognize documentation that does not adequately support the level of service or medical necessity. #J-18808-Ljbffr