We invite you to join a team of highly skilled emergency medical experts, pilots and mechanics! Our mission of providing care to the world at a moment's notice is at the heart of everything we do. We are caregivers, first and foremost and we will be there when you need us.
With more than 38,000 employees, Global Medical Response teams deliver compassionate, quality medical care, primarily in the areas of emergency and patient relocation services around the world. We provide end-to-end medical transportation as well as fire services, integrated healthcare solutions and disaster response.
JOB SUMMARY
Provides the Utilization Review on all patient flights for all ambulance programs through accurate International Classification of Diseases (ICD-10) coding, clinical billing narratives, clinical risk/medical necessity evaluation and evaluation/submission of all medical necessity appeals.
ESSENTIAL FUNCTIONS/DUTIES
Pre-claim review process
Conducts the import from the electronic flight record export to Sweet Billing to ensure timely, accurate and compliant billing
Reviews all flight record documentation for the purpose of assigning the proper ICD-10's to the highest level of specificity in the proper order/priority
Utilizes written standards of care, professional physician position papers, and air medical transport criteria to determine the medical necessity for billing air rates and the mileage billing rate (closest medical receiving facility)
Provides an assessment of quality of patient care and notifies the proper clinical contact
Conducts the initial review of the billing record to ensure data accuracy
Conducts the medical necessity appeals for all payor sources
Receives the appeal request from Patient Accounts and inputs the information into the Appeals Data Base
Ensures appeals timelines are met by moving the assigned book of business through the appeals process and updates the appeals data base
Works with the Patient Accounts Appeals Department to ensure that the maximum amount appealed for is allowed
QUALIFICATIONS
Experience:
Minimum of Five years in Emergency department (ED), Intensive Care Unit (ICU), or ambulance experience or job experience equivalent
Two years management/leadership experience preferred
Education:
Current RN licensure in state of residence
Skills:
Ability to define problems, collect data, establish facts, and draw valid conclusions
Ability to respond to inquires or complaints from customers in a positive and productive manner
WORKING CONDITIONS AND MENTAL/PHYSICAL REQUIREMENTS
Physical Demands:
Duties require the employee to regularly reach with hands and arms; speak and hear
Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus
GUIDING VALUES AND BEHAVIORS
Employee must consistently exhibit our guiding principles:
Patient Care - We continually earn the privilege to care for our patients. It is at the forefront of everything we do.
One Team - We respect each other and achieve together what no individual can alone.
Innovation - We are driven to develop solutions that inspire progress.
Vigilance - We will never waver in our commitment to safety and preparedness in the fulfillment of our duties.
Ownership - We are accountable for what we do and take pride in how we do it.
Citizenship - We are dedicated to being good stewards in the communities we serve.
#GMR_Air
EEO Statement
Global Medical Response and its family of companies are an Equal Opportunity Employer including Veterans and Disabled
