Medical Billing Specialist

Description

The Billing Specialist is responsible for ensuring timely and accurate claim preparation, coding review, payment posting, and front-end denial resolution to maximize reimbursement and maintain compliance. This position serves as a critical link between field operations and the billing department by reviewing patient care documentation, coordinating corrections with EMS crews, and ensuring claims are complete before submission. The Billing Specialist helps maintain a clean claims pipeline while supporting Team Mobile Health Care’s commitment to financial stewardship and exceptional patient service.

Requirements

•   Review Patient Care Reports (PCRs) for completeness, accuracy, and billing readiness.
• Apply appropriate coding in accordance with Medicare, Medicaid, and commercial payer guidelines.
• Submit clean claims while maintaining high first-pass acceptance rates.
• Investigate and resolve front-end claim edits and electronic claim rejections.
• Work front-end insurance denials to prevent delays in reimbursement.
• Monitor payer updates and implement changes to billing requirements, coding guidance, and reimbursement policies.
• Return incomplete or inaccurate PCRs to field staff for correction and follow through until documentation requirements are met.
• Coordinate with Operations, Dispatch, and clinical staff to obtain missing documentation required for billing.
• Post insurance payments, patient payments, contractual adjustments, and other payment transactions accurately and timely.
• Reconcile payment postings and identify discrepancies requiring investigation.
• Maintain accurate documentation of billing activities within the billing system.
• Assist with month-end reconciliation activities as assigned.
• Identify billing trends and communicate opportunities for process improvement.
• Maintain confidentiality and compliance with HIPAA and all applicable healthcare regulations.
• Participate in departmental quality assurance initiatives and continuous improvement efforts.
• Perform other duties as assigned.

Minimum Qualifications

• High school diploma or GED required.
• Two years of medical billing experience preferred.
• Experience with ambulance or EMS billing strongly preferred.
• Knowledge of ICD-10, HCPCS, and CPT coding principles.
• Experience with Medicare, Medicaid, and commercial insurance billing.
• Proficiency using electronic billing software and Microsoft Office.

Knowledge, Skills & Abilities

• Strong understanding of revenue cycle processes.
• Excellent organizational and time management skills.
• High level of accuracy and attention to detail.
• Strong analytical and problem-solving abilities.
• Ability to manage multiple priorities in a fast-paced environment.
• Excellent written and verbal communication skills.
• Ability to work collaboratively with field staff and leadership.