Sr Medicare Biller
Empress EMS
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
- 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
- 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
- Office-based or hybrid role depending on company needs
- Fast-paced EMS billing environment with high-volume claim processing
Vacancy posted 4 days ago
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