EMS Medical Coding Specialist

Job description

**About Us:** At Paramedic Services of Illinois, we are dedicated to providing compassionate and high-quality emergency medical care to our community. Our company culture is centered around the belief that every individual deserves prompt and professional medical attention delivered with empathy and respect. **Position Summary:** The EMS Medical Coding Specialist is responsible for accurate and compliant assignment of diagnosis and procedure codes to emergency medical services encounters, including ground and air ambulance transports. This senior-level position requires expert knowledge of ICD-10-CM, HCPCS Level II coding conventions, and Medicare/Medicaid billing regulations specific to EMS transport services. The specialist ensures optimal reimbursement while maintaining strict adherence to federal and state compliance requirements. ### Medical Coding & Documentation: - Review and abstract patient care reports (PCRs) to assign accurate ICD-10-CM diagnosis codes and HCPCS transport codes (A0426–A0436). - Evaluate medical necessity documentation to support BLS, ALS-1, ALS-2, and specialty care transport (SCT) levels. - Apply modifiers (e.g., QL, QM, QN) correctly for Medicare and Medicaid claims. - Query EMS providers for incomplete or ambiguous clinical documentation in accordance with AHIMA query guidelines. - Maintain coding accuracy rate of 95% or above on internal and external audits ### Billing & Claims Management: - Submit clean claims to Medicare, Medicaid, and commercial payers following payer-specific guidelines. - Review and resolve coding-related claim denials, underpayments, and appeals. - Identify and escalate patterns of denial or documentation deficiency to management. - Coordinate with billing staff to ensure seamless claims submission and follow-up. ### Compliance & Quality Assurance: - Ensure coding practices comply with OIG guidelines, HIPAA, and payer-specific policies. - Participate in internal audits and respond to external audit requests. - Monitor and implement updates related to annual HCPCS/ICD-10 code changes and CMS rulemaking. - Maintain current knowledge of Local Coverage Determinations (LCDs) for ambulance services. ### Required Qualifications & Skills: - Minimum 3–5 years of EMS/ambulance medical coding experience. - Active CPC, CCS, or COC credential from AAPC or AHIMA; CPC-P or AMPA EMT-Coder preferred. - Expert-level knowledge of ICD-10-CM, HCPCS Level II, and CMS ambulance billing rules. - Demonstrated experience with Medicare ambulance billing, including ABN requirements and transport certification statements. - Proficiency with EMS billing software (e.g., Zoll Billing, TriTech, ESO, ImageTrend). - Strong understanding of federal and state ambulance reimbursement regulations. - High school diploma or GED required; Associate's or Bachelor's degree in Health Information Management preferred. ### Preferred Qualifications: - Certified Ambulance Coder (CAC), Certified Professional Coder (CPC), or other revenue cycle certification. - Familiarity with value-based care models and ET3 (Emergency Triage, Treat, and Transport) program billing. - Knowledge of state-specific Medicaid managed care ambulance reimbursement policies. - Experience with revenue cycle analytics and reporting tools. ### Work Environment & Benefits: - **Employment Type:** Full-time - **Compensation:** Competitive hourly pay based on experience. - **Benefits:** Health, dental, vision, 401(k), paid time off, professional development opportunities.