Quick Med Claims (QMC) is a nationally recognized leader in emergency medical transportation billing and reimbursement. QMC is committed to providing services in a manner that ensures compliance with all applicable billing and reimbursement regulations while maximizing the capture of allowable reimbursement for each client. The commitment to adherence to both principles make QMC the partner of choice for emergency medical transportation providers.
QMC is headquartered in Pittsburgh, PA. This position is remote.
Summary
The Billing Specialist I will utilize master billing guides and other process instructions to review PCR to ensure medical necessity, reasonableness, level of service, ICD10 coding and mileage is correct. This role is fundamental in QMC's revenue cycle management process and ensures that claims are coded and billed accurately and timely. The selected Billing Specialist I will maintain a strong working knowledge of billing rules and regulations for all payor types in the various regions for which they process claims.
Responsibilities
Review patient medical records and supporting documentation.
Add required data elements to the account in RescueNet including ICD9 code, charges and billing narrative.
Follow up with insurance carriers on the status of past due accounts
Contact patients, hospitals, attorneys and other parties to obtain insurance information
Review claims that have been denied by insurance carriers and submit corrected claims or appeals as necessary.
Ensure all tasks are completed according to Quick Med Claims policies as well as state and federal guidelines.
Meeting or exceeding defined productivity standards of the position
Responsible for properly notating accounts reviewed.
Responsible for attaching necessary documentation within the system or to paper 1500’s.
Calling patients, facilities, insurances, and attorneys as needed to research claims.
Verify patient’s insurance information utilizing various resources such as websites, telephone, IVR, and provider CSR’s when applicable.
Generate and follow up on self-pay bills to patients for that portion of the bill not covered by third party insurance.
Respond to patient calls related to billing inquiries and follow up.
Work return mail and bad address accounts as needed.
Obtain additional information from clients when needed, such as HIPAA forms, pre authorizations from insurance companies and physician medical necessity forms in order to submit third party claims.
Create, review, and complete billing documents on Rescue Net by using dates provided on patient care reports, physician medical necessity forms and hospital face sheets.
Review and submit finalized claims either on 1500 paper forms with supporting documentation or electronically.
Review edits and rejections stemming from electronic billing and the correction and resubmitting of the same.
Review denials making adjustments and/or corrections in order to resubmit claims for payment.
File appeals when necessary in order to have a denial decision reversed.
Submit 1500 forms to secondary insurance companies with required documentation such as explanation of benefit forms from primary insurance companies.
Maintaining workflow to keep aging accounts at a minimum by following up on unpaid claims on a daily basis.
Responsible for follow up on all assigned accounts that have reached collections to ensure they have been fully worked before turning them over to a collection agency.
Process all insurance claim forms in accordance with Federal and State laws as well as departmental procedures.
Requirements
Qualifications:
High school diploma or equivalent is required
1+ years of work experience in medical billing and coding preferably with EMS or ambulance claims required
1+ years of experience navigating electronic and paper medical record systems required
1+ years of experience preparing and submitting clean claims to various insurance companies required
Medical billing certification or degree from a technical school or college preferred