Job Title: Third Party Billing Associate - Hybrid
Work Location: Oklahoma City, OK
Division/Department: PMBS

The position is responsible for the billing, follow-up, collection, and resolution of ambulance claims submitted to third party payers. This position works accounts across Oklahoma, Arkansas, Mississippi, Louisiana, and Texas and is responsible for ensuring claims are processed accurately, followed up timely, and resolved in accordance with payer requirements and company policies.

They manage assigned accounts from initial claim submission through final payment or appropriate resolution. This includes reviewing claim status, working denials and rejections, submitting corrected claims and appeals, identifying coordination-of-benefits issues, reviewing payments and underpayments, and communicating with insurance carriers and patients when additional information is required.

Essential Duties and Responsibilities

Accounts Receivable Follow-Up

• Review payer portals, electronic claim status, remittance information, and other available resources to determine claim status.
• Contact insurance carriers when additional information is required to resolve outstanding claims.
• Identify claims that have not processed within expected payer timeframes and initiate appropriate follow-up.

Denials & Rejections

• Review and resolve Medicaid claim denials and rejections.
• Identify the underlying reason for denial and determine the appropriate corrective action.
• Correct billing or claim information when appropriate.
• Submit reconsiderations or appeals with supporting documentation when warranted.
• Monitor appealed or corrected claims through final resolution.

Payment & Remittance Review

• Review Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) information to determine appropriate next action.
• Identify denials, underpayments, non-covered services, coordination-of-benefits issues, and other payment discrepancies.
• Ensure contractual adjustments and patient responsibility are appropriate before account resolution.
• Identify inappropriate payer reductions or processing issues and initiate follow-up when necessary.

Patient Responsibility & Coordination of Benefits

• Determine when balances should appropriately be transferred to patient responsibility.
• Request updated insurance or coordination-of-benefits information when necessary.
• Ensure all appropriate insurance billing options have been addressed before transferring balances to the patient.
• Follow company policy regarding patient billing and account resolution.

Minimum Qualifications

• Knowledge of medical billing and accounts receivable processes.
• Knowledge of Commercial insurance, Medicare and Medicaid billing preferred.
• Ability to read and interpret EOBs, ERAs, payer correspondence, claim status information, and denial codes.
• Understanding of electronic claim submission, corrected claims, appeals, coordination of benefits, and timely filing.

Education & Experience Requirements

• High school diploma or equivalent required.
• Medical billing, insurance follow-up, accounts receivable, or related healthcare experience preferred.

Physical Requirements

• Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other federal, state and local standards, including meeting qualitative and/or quantitative productivity standards.
• Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards.
• The employee may occasionally be required to lift and/or move up to 20 pounds
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
• Work may require sitting, lifting, stooping, bending, stretching, walking, standing, pushing, pulling, reaching, and other physical exertion.
• Must be able to talk, listen and speak clearly on telephone.
• Must possess visual acuity to prepare and analyze data and figures, operate a computer terminal, and operate a motor vehicle.

Other Requirements

• Must have access to high-speed internet-at least 20mbps download, and must be hardwired
• In person and hybrid in the Oklahoma City area-Will be in the office 2-3 times a week, could be more at times depending on volume or issues that may occur

Travel Time

• Negligible

NOTE: The above statements are intended to describe the general nature and level of work being performed by the person assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties, skills and physical demands required of personnel so classified.