Sr Medicare Biller

Position SummaryThe 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.Key ResponsibilitiesProcess, review, and submit Medicare claims for emergency and non-emergency ambulance services in accordance with CMS and New York State regulationsEnsure 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 recordsIdentify, research, and resolve Medicare denials, underpayments, and rejectionsPrepare and submit redetermination, reconsiderations, and higher-level appeals as neededCoordinate Medicare crossover claims to New York State Medicaid and other secondary insurersMaintain compliance with CMS guidelines, OIG standards, HIPAA, and company policiesMonitor aging reports, follow up on unpaid or delayed claims, and ensure timely resolutionAct as a resource and mentor to billing staff, providing training and guidance on Medicare-related issuesAssist with audits, compliance reviews, and internal quality assurance initiativesCommunicate effectively with Medicare Administrative Contractors (MACs), Medicaid, and internal departmentsStay current on Medicare policy updates, fee schedule changes, and regulatory requirements QualificationsMinimum of 3-5 years of Medicare ambulance billing experience requiredIn-depth knowledge of CMS ambulance billing regulations and New York State billing practicesStrong understanding of medical necessity requirements and documentation standardsExperience with Medicare appeals and denial resolutionProficiency with ambulance billing software and electronic claim submission systemsHigh attention to detail and strong analytical skillsAbility to prioritize workload and meet deadlines in a fast-paced environmentExcellent written and verbal communication skillsAbility to maintain confidentiality and compliance with HIPAA regulations Preferred QualificationsExperience with New York State Medicaid, No-Fault, and Workers' Compensation coordinationPrior supervisory or lead billing experienceFamiliarity with compliance audits and payer reviewsCAC, CPC, CPB, or other relevant billing/coding certification Work EnvironmentOffice-based or hybrid role depending on company needsFast-paced EMS billing environment with high-volume claim processing