Sr Medicare Biller

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Job Title

Sr Medicare Biller

Location

Yonkers, NY

Department

Billing

FLSA Status

Exempt

Reports To

Jahaira Gomez

Shifts Hiring

Full-time

Pay Grade

63,700/Per Year

Position Summary

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.

Key Responsibilities

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

Qualifications

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

Preferred Qualifications

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

Work Environment