Sr Medicare Biller posted about ago Nationwide

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.

• 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

We are an equal opportunity employer. Our recruitment, selection and hiring strategies are designed to attract, develop and advance exceptional individuals regardless of race, color, sexual orientation, religion, age, gender, disability or any other legally protected status. We actively recruit military veterans.