Billing Auditor - Irving - CareFlite

Description

Billing Auditor

Company Description: CareFlite is a 501(c)(3) nonprofit ambulance service sponsored by Baylor Scott & White Health, JPS Health Network, Methodist Health System, Parkland, and Texas Health Resources. CareFlite provides medical transport by helicopter, airplane, and ground ambulance, and non-medical transport via wheelchair van.

Job Description

The Billing Auditor plays a critical role in ensuring the accuracy, completeness, and compliance of all patient care documentation prior to billing. This position requires strong analytical ability, independent judgment, and exceptional attention to detail when reviewing electronic Patient Care Records (ePCRs), Physician Certification Statements (PCS), face sheets, and related documentation.

A core responsibility of this role is the continuous improvement of PCR quality. The Billing Auditor ensures each record meets payer, regulatory, and internal standards before submission to CareFlite's third-party billing partner.

Equally essential is the maintaining strong, collaborative relationships with ground crews by providing clarification, education, and real-time support to reinforce the importance of accurate billing documentation and its direct impact on CareFlite's mission, patient advocacy standards, and documentation integrity.

The Billing Auditor serves as a key link between field operations, the Integrated Billing Services team, and external billing partners. This position ensures compliance with Medicare, Medicaid, commercial insurance requirements, HIPAA, state EMS regulations, and CareFlite policies, while supporting audits, reporting, and departmental process-improvement initiatives.

Key Responsibilities

Documentation Review & Pre-Billing Audits

• Review daily ePCRs and associated documentation to ensure accuracy, completeness, compliance, and readiness for billing.
• Conduct pre-billing audits and return PCRs to crews for correction or clarification as necessary.
• Identify documentation trends affecting billing performance and communicate findings to Integrated Billing Services leadership.
• Review PCS forms, face sheets, signatures, mileage, and all documentation required for compliant EMS claims.

Crew Engagement & Support

• Communicate daily with crew members who have pending, missing, or incomplete PCRs to ensure timely completion before the end of their shift.
• Assist crews with documentation or billing questions and provide clarification on payer requirements and documentation standards.
• Build and maintain positive relationships with crews to promote CareFlite's mission, standards of patient advocacy, operational excellence, and documentation integrity.
• Participate in education initiatives, meetings, or targeted follow-ups to reinforce proper documentation practices.
• Provide feedback to assist in the development and refinement of documentation training materials, policies, and crew education initiatives.

Billing Cycle Support & Departmental Assistance

• Obtain, scan, and attach required documents to the ePCR or billing software when not automatically linked.
• Support the Integrated Billing Services Manager, Billing Coordinator, and Custodian of Records with departmental needs as required.
• Document audit activities, findings, and communication per departmental procedures.

Compliance & Regulatory Requirements

• Ensure adherence to federal, state, and organizational billing procedures, including Medicare, Medicaid, commercial payor requirements, and HIPAA.
• Maintain working knowledge of ambulance billing regulations, state EMS rules (including TAC 157), and internal CareFlite processes.
• Maintain strict confidentiality of medical and financial information in accordance with HIPAA and CareFlite policies.

Professionalism & Administrative Duties

• Communicate professionally and respectfully with internal staff, field crews, external partners, healthcare facilities, and third-party billing entities.
• Demonstrate regular attendance, punctuality, and the ability to perform duties independently.
• Attend at least 75% of quarterly staff meetings.
• Represent CareFlite in a courteous, professional manner with a positive customer service demeanor.
• Perform other duties as assigned while contributing to a respectful and collaborative work environment.

Core Competencies

• Teamwork: Collaborates effectively with departments, field crews, and leadership to support accurate billing processes.
• Communication: Communicates clearly, respectfully, and professionally with internal and external stakeholders.
• Problem Solving: Applies critical thinking and resourcefulness to resolve documentation discrepancies.
• Integrity: Maintains confidentiality and adheres to organizational policies and ethical standards.
• Patient Focus: Demonstrates a commitment to accuracy and timeliness in documentation to support patient billing needs.

Working Conditions

Hours of Work

• Hourly position: hours vary based on business needs.

Overtime Expectations

• Overtime may be required as needed to meet departmental deadlines or operational requirements.

Work Environment

• This role is performed on-site at CareFlite's Corporate Headquarters in Irving, Texas. The work environment is a standard office setting with consistent computer use, regular engagement with internal departments, and regular interaction with field operations. Employees are expected to maintain professionalism and adhere to all organizational policies while on premises.

Travel Requirements

• No travel is required for this position.

On-call Responsibilities

• There are no routine on-call requirements. Limited after-hours availability may be requested for urgent billing or audit matters.

Special Conditions or Requirements

• Completion of all required CareFlite remote onboarding and training programs.
• Participation in ongoing compliance, HIPAA, and billing training as required.
• Maintain necessary certifications or credentials relevant to the position.

ADA Physical and Mental Requirements

Physical Demands

• Prolonged sitting, frequent use of computers, occasional reaching or lifting up to 20 pounds (e.g., documents, equipment).
• Must be able to set up and maintain a safe and ergonomic home workstation (desk, chair, monitor height, keyboard/mouse setup).
• Ability to perform computer-based tasks for extended periods without injury or strain.
• Ability to take breaks as needed to prevent repetitive strain injuries (RSI) or eye strain.

Sensory and Environmental Requirements

• Ability to use a computer and office equipment, with adequate lighting and minimal distractions in the home workspace.
• Ability to use assistive technology if needed (screen readers, voice recognition, adaptive keyboards, etc.).
• Must have access to a quiet and well-lit workspace suitable for focused work and video/phone meetings.
• Must maintain a stable and secure internet connection to complete work tasks efficiently.
• Ability to manage environmental distractions to maintain productivity and confidentiality.

Mental and Emotional Requirements

• Ability to manage multiple tasks independently, handle confidential information, and maintain focus in a remote environment.
• Must demonstrate professional communication and resilience when addressing billing or documentation concerns.
• Self-motivation and time management skills to work independently.
• Ability to maintain professional communication virtually and handle confidential information responsibly.
• Adaptability to changing priorities, systems, or processes in a remote environment.

Qualifications

Required Qualifications

• Must be 18 years of age or older.
• High school diploma or equivalent.
• Prior EMS field experience (EMT or paramedic) or previous experience in ambulance pre-billing, EMS ePCR review, or emergency medical documentation auditing.
• Proficient in computer systems, electronic data processing, and modern office practices.
• Working knowledge of Medicare, Medicaid, and other public health plan billing requirements.
• Strong understanding of medical terminology and basic medical documentation standards.
• Ability to communicate clearly