Billing Resolution Specialist I

This position is 100% Remote.

The Billing Resolution Specialist (BRSI) plays an important and fundamental role in QMC’s RCM process by ensuring claims are coded and billed accurately and timely. The BRSI must maintain a strong working knowledge of billing rules and regulations for all payor types in the various regions for which they process claims. The BRSI must be detailed oriented and driven by the highest quality standards. The BRSI is focused primary on resolving any issue that keeps a claim from being released to the appropriate payor. 

Maintaining the highest quality billing standards is critical to QMC achieving its overall quality goals and vision to be the trusted partner of choice that 100% of our clients would recommend to a friend or colleague.  

Responsibilities:

• Reviews and manages the following workflows: 
• Deductible Management
• Bad Addresses (various systems – billing platform and ImageSilo)
• SNF Calls for Part A check
• Patient Services
• Insurance Captured
• PCS (and SendPro requests)
• ZDBatch Failures
• AOBs (via eServices & ImageSilo)
• Biller Attention Needed
• ACE Exception Portal
• Membership Checks after Insurance Pays
• In addition, for Danville, the below will also be review and manage:
• ALS Reports Folder
• ALS Release Schedule
• JBA (Joint Billing Agreement) Manual Review 
• Attach DocStar documents to RescueNet for processing 
• Monitors and processes incoming fax que (Ring Central)
• Manually enters claims directly to payors when required by Medicaid and other secondary payors
• Completes Authorization requests when required 
• Attends and actively participates in daily Billing team huddles
• Consistently achieves Billing Resolution daily performance and quality metrics

Other Responsibilities:

• Adhere to all QMC HIPAA privacy policies and procedures. This includes always maintaining the confidentiality and security of sensitive patient information.
• Ensures consistent adherence to company attendance policies.

Education:  

High School Diploma required 

Experience: 

3+ years EMS Billing preferred  

Licenses, Certifications & Clearances:  

Certified Ambulance Coder (CAC)

QMC F10 Certified

Knowledge, Skills, Abilities:  

• Very detailed-oriented
• Strong, working knowledge of EMS billing rules and regulations and understanding of health insurance payor groups (Medicare, Medicaid, Commercia)
• Ability to identify problems and escalate issues appropriately to a Billing Lead
• Ability to quickly adapt, learn and retain changing rules and specifications by clients, payors, states and MAC regions
• Quality-focused and driven by process
• Excellent problem solving skills
• RescueNet or Tritech billing platform knowledge (preferred)