POSITION SUMMARY

The Pre-Billing Specialist reviews the patient transport entered in the CAD for accuracy of input and the correct payor is chosen before the transport is dispatched.

DUTIES/RESPONSIBILITIES

• Review patient demographic information including name, address, phone number, date of birth, insurance information, etc. to ensure complete and accurate data.
• Search approved systems for additional patient demographics and insurance information.
• Assist in filing all claims by verifying insurance prior to dispatching of transportation resources.
• Checks current coverage and assigns primary policy billing in workflows.
• Provides proactive efforts to resolve insurance and patient billing problems.
• Manage the Repetitive Patient process for payor, payments and Medicare portal input of data needed.
• Follows up on Medicare Repetitive Trip portal for approvals and denials.
• Monitor and investigate “Medical Necessity” description quality as provided by call intake.
• Works with Operations to correct any invalid/improper forms and signatures.
• Performs duties in a productive/timely manner as well as maintaining accuracy in the Billing / pre-verification process.
• Makes outbound phone calls to the patient or patient’s Next of kin for payment when there is no insurance to cover the transport fee.
  • This will include calling the hospital or facility for a phone number for patient or Next of Kin if none is provided at the time transport was scheduled.
• Works with Communications Center Staff to provide guidance surrounding non-emergency transports and the paperwork, payment or authorizations needed prior to sending a unit to pick up the patient.
• Request or review trailing documents such as the hospital face sheet or PCS form for completeness and accuracy.
• Complete credit card transactions for fees for transportation from the patient or Next of Kin.
• Ensures all signatures, physician certification statements, and prior authorizations are valid prior to submission to billing.
• Identify and assist in correcting productivity lags throughout the prebilling process.
• Demonstrates professional growth through periodic participation in continuing education/development programs.
• Serve as on-call for dispatch billing questions
• Complete other duties assigned.
• Communicate a willingness to help others succeed.
• Demonstrate an ability to communicate and work well with others (e.g., customers, facilities, MedFleet Communications, and payors.
• Convey and inspire a sense of competence and commitment.
• Meets established daily billing productivity goals.

POSITION QUALIFICATIONS

Minimum Qualifications/Skills

• High School Diploma or GED.
• Work with computer programs, software’s including but not limited to Microsoft Office, and other basic computer functions.
• Work with the public; Customer service.
• General knowledge of medical and insurance industry terminology
• ICD-9 coding and automated patient accounting system and/or electronic billing systems experience.
• Documentation of completion of requisite Medicare/Medicaid update courses and industry courses.
• Communicate clearly in English, both verbally and in writing to convey information distinctively and concisely. Use appropriate grammar and punctuation in written documents.
• Typing and 10-key skills.

Preferred Qualifications/Skills

• Three years of medical terminology.
• Knowledge of HIPAA and other critical governmental regulations.
• Knowledge of insurance policies including benefit discernment.
• Knowledge of automated patient accounting systems and/or electronic billing systems.
• Experience in ambulance industry preferred.

Working Environment

Professional office environment

Physical Requirements

• Occasional lifting of office supplies and other material associated with position
• Requirements will vary; must be able to perform the essential duties of position with or without a reasonable accommodation.