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Summary:

The Billing & Authorization Specialist ensures accurate and timely processing of EMS and Transfer related authorizations, billing, and records management to support patient care and organizational compliance.

This role is responsible for managing pre-certification and prior authorization processes, resolving denied claims, and auditing transportation invoices to verify service levels, insurance coverage, and medical necessity.

The specialist also oversees EMS agency billing activities, coordinates with internal departments and external vendors, and serves as the department’s Keeper of the Records.
Position Responsibilities:

Prepares, verifies, submits, registers and manages the pre-certification and/or prior authorization process for all applicable patient encounters. Utilization of payer websites, faxes, and phone.

Directly manages denied claims working with the insurance companies and Patient Accounting Department.

Reviews, audits and reconciles EMS agency invoices, Medicaid trips and prepares requisitions for payment, coordinating with Billing Manager, legal office, Accounts Payable and Purchasing.

Reviews invoices from non-Virtua transportation agencies related to interhospital and discharge transport. Audits invoices to ensure proper level of service, insurance authorization and medical necessity. Interacts with Hospital management, and Case Management and Patient Accounting when necessary to approve payment for certain transport.

Functions as Department “Keeper of the Records” and interacts with internal HIM and legal staff, external law offices, and patients in the handling and processing of all subpoenas and requests for medical records.

Position Qualifications Required:

Required Experience:

2-3 years of EMS registration coding and billing experience required.

2-3 years Insurance Authorization experience required.

Understanding of third-party reimbursement and methodologies for all third party payers, especially pre-certification and COB regulations.

Working knowledge MS Excel as well as various PBS related applications or demonstrated computer proficiency with ability to learn new applications as required.

Required Education:

High School Diploma required.

Training / Certification / Licensure:

Certified Heath Care Access Associate (CHAA) certification required within first year in position.

Hourly Rate: $22.46 - $33.71 The actual salary/rate will vary based on applicant’s experience as well as internal equity and alignment with market data.

Virtua offers a comprehensive package of benefits for full-time and part-time colleagues, including, but not limited to: medical/prescription, dental and vision insurance; health and dependent care flexible spending accounts; 403(b) (401(k) subject to collective bargaining agreement); paid time off, paid sick leave as provided under state and local paid sick leave laws, short-term disability and optional long-term disability, colleague and dependent life insurance and supplemental life and AD&D insurance; tuition assistance, and an employee assistance program that includes free counseling sessions. Eligibility for benefits is governed by the applicable plan documents and policies.

For more benefits information click here.