Medical Biller: TransCare

Responsibilities:

1) Check Insurance eligibility via phone or internet websites for all transports. Obtain insurance authorization for all applicable transports when needed.

2) Review all ambulance call reports against the claim information in billing system for patient demographics, date of service, origin, destination, primary & secondary insurances and update all changes to claim in computer.

3) Verify correct HCPCS code and level of service and assign applicable ICD-9 illness codes to all claims during review of each ACR. Review and interpret all medical necessity information found. Add any additional services or procedures completed to claim like Oxygen & EKG.

4) Review Physician Certification Statements (PCS) for content and appropriate guidelines. Enter PCS data into claim. For all appropriate Medicare transports an additional free form narrative must be written detailing Medical Necessity of patient during transport.

5) Provide feedback to Quality Assurance department of quality of Medical Necessity Information captured by crews during transports.

6) Upon completion of all above, clean claim can be marked verified in pre-billing.

7) Print HCFA 1500 claims forms for submission to insurance companies, attach EOB for secondary insurances, attach ACR when required to go with HCFA. Stuff all HCFA in envelopes for mailing.

8) Download data to electronic billing systems. Follow individual requirement for each user to send claims. Upload all confirmations and edits for review and resubmission.

9) Print and distribute Prior Approval forms for NY State Medicaid. Log in all returned approval forms. Call ordering facilities for updates on outstanding forms not returned.

10) Post all payment and denial to claims in computer via batch by deposit date. Reconcile all payments posted to daily cash deposits reports. Send all batches to be scanned.

11) Run and work off A/R reports for open claims.

12) Read denial & EOB’s. Follow up issues with insurance representatives like denial, incorrect payment, reprocessing of claims & appeals. Rebill, appeal and resubmit all applicable claims.

13) Phone contact with patients for insurance information, billing questions, secondary insurances. Submit all applicable claims to patient and or insurance.

14) Develop and maintain contacts at facilities for insurance look up information.

15) Review overpayment and request refund & correct adjustments to claims. Submit refund requests to Accounts payable. Upon receipt of refund checks enter information in claim and mail refund to applicable patients and/or insurance companies.

16) Provide feedback to Management on all negative & positive trends in payments and/or denials.

Position Qualifications:

1 year Minimum Experience in Medical Billing

Knowledge of Medical Terminology

ICD-9 & HCPCS coding

HCFA 1500 claim forms

Electronic Billing systems

Excel

Word

The ideal candidate must be able to communicate clearly and professionally with Management, Insurance companies, & peers. Must be able to Multi-task and work well in group situations.

To apply, please go to www.transcare.jobs.