Mecklenburg EMS Agency (Medic) · 8 hours ago
Revenue Cycle Associate - Claims & Denials
Charlotte, NC
Full-time
Onsite
New Grad, Entry LevelMecklenburg EMS Agency (Medic) is seeking a Revenue Cycle Associate specializing in Claims and Denials. The role involves managing medical claims denials and insurance follow-up, ensuring proper adjudication and payment of accounts while maintaining compliance with billing practices and regulations.
Emergency MedicineHealth CareHospital
Responsibilities
Apply in-depth knowledge of medical claims denial and insurance follow-up to independently review accounts and take action for proper adjudication and payment
Manage incoming correspondence from payors and respond timely to ensure claims are processed and resolved efficiently
Prepare and submit payor appeals with supporting documentation; utilize external payor portals for claims management, follow-up, and appeal submission
Contact insurance payors via phone or electronic means to obtain claim status updates and pursue resolution
Interpret claim edits, rejections, and coverage guidelines to identify appropriate solutions and minimize delays in reimbursement
Accurately update patient accounting systems with correct demographic and insurance data, documenting all actions taken on accounts
Analyze denial trends, identify root causes, and assess the impact on accounts receivable; recommend or initiate corrective action as needed
Manage assigned work queues efficiently to meet established productivity and quality standards, preventing timely filing denials
Maintain up-to-date knowledge of Medicare, Medicaid, Medicare Advantage, Managed Care, and Commercial insurance billing practices, including fee schedules and consolidated billing
Apply understanding of ambulance medical billing, documentation requirements (e.g., PCS forms, transfer of care, certification levels), and compliance with federal and state coding guidelines
Write and file detailed appeals with insurance carriers, using clinical coverage policies and payer-specific documentation requirements
Review insurance claim forms, remittances, and correspondence to ensure accurate payment and resolve claim denials
Demonstrate strong analytical and critical thinking skills to apply payer-specific coverage policies effectively
Stay current on ambulance coding, regulatory billing guidelines, and changes in insurance laws and reimbursement policies
Maintain confidentiality and comply with all HIPAA and privacy standards, federal and state regulations, and the agency’s compliance program
Collaborate cross-functionally and continuously seek ways to improve workflow, customer service, and internal operations
Provide quality customer service to patients, including verifying insurance, responding to inquiries, resolving account issues, and ensuring timely follow-up
Proficiently use billing software, clearinghouses, and relevant tools for electronic claim submission and account management
Demonstrate flexibility by supporting other revenue cycle functions when needed, such as registration, coding, cash posting, and payment posting
Maintain positive working relationships with internal departments, external payors, and the general public
Qualification
Required
Apply in-depth knowledge of medical claims denial and insurance follow-up to independently review accounts and take action for proper adjudication and payment
Manage incoming correspondence from payors and respond timely to ensure claims are processed and resolved efficiently
Prepare and submit payor appeals with supporting documentation; utilize external payor portals for claims management, follow-up, and appeal submission
Contact insurance payors via phone or electronic means to obtain claim status updates and pursue resolution
Interpret claim edits, rejections, and coverage guidelines to identify appropriate solutions and minimize delays in reimbursement
Accurately update patient accounting systems with correct demographic and insurance data, documenting all actions taken on accounts
Analyze denial trends, identify root causes, and assess the impact on accounts receivable; recommend or initiate corrective action as needed
Manage assigned work queues efficiently to meet established productivity and quality standards, preventing timely filing denials
Maintain up-to-date knowledge of Medicare, Medicaid, Medicare Advantage, Managed Care, and Commercial insurance billing practices, including fee schedules and consolidated billing
Apply understanding of ambulance medical billing, documentation requirements (e.g., PCS forms, transfer of care, certification levels), and compliance with federal and state coding guidelines
Write and file detailed appeals with insurance carriers, using clinical coverage policies and payer-specific documentation requirements
Review insurance claim forms, remittances, and correspondence to ensure accurate payment and resolve claim denials
Demonstrate strong analytical and critical thinking skills to apply payer-specific coverage policies effectively
Stay current on ambulance coding, regulatory billing guidelines, and changes in insurance laws and reimbursement policies
Maintain confidentiality and comply with all HIPAA and privacy standards, federal and state regulations, and the agency's compliance program
Collaborate cross-functionally and continuously seek ways to improve workflow, customer service, and internal operations
Provide quality customer service to patients, including verifying insurance, responding to inquiries, resolving account issues, and ensuring timely follow-up
Proficiently use billing software, clearinghouses, and relevant tools for electronic claim submission and account management
Demonstrate flexibility by supporting other revenue cycle functions when needed, such as registration, coding, cash posting, and payment posting
Maintain positive working relationships with internal departments, external payors, and the general public
Experience in the healthcare revenue cycle process
Experience working insurance denials and appeals
Familiarity with payer portals and clearinghouses
Excellent verbal communication skills
Demonstrated ability in the use of Microsoft products
Ability to perceive and distinguish emotions during interactions with people via telephone and respond courteously
Maintain acceptable attendance and adhere to scheduled work hours
Ability to work within a team-oriented, fast-paced, customer focused environment
HS diploma/GED required
Preferred
Associate degree preferred
Certified Ambulance Coder (initial certification only) preferred
Company
Mecklenburg EMS Agency (Medic)
Medic (also known as Mecklenburg EMS Agency) has served Mecklenburg County since 1978 and is one of the largest EMS agencies in North Carolina responding to over 150K 911 calls every year.
Founded in 1978
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Scott Wilson
Paramedic Crew Chief, Special Operations Paramedic, Relief Ops Supervisor, Field Training Officer
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