Specialty Claims Specialist at AmeriPro Health · Ho Chi…

Overview

OverviewThe Specialty Claims Specialist is responsible for the review, resolution, and escalation of complex ambulance claims at AmeriPro Health. This role primarily focuses on appeals, denials management, underpayments, and difficult reimbursement scenarios across Medicare, Medicaid, Managed Care, Commercial, and Workers’ Compensation payors. Serving as a subject matter expert for high-value and high-complexity accounts, this individual utilizes advanced claims research, documentation review, regulatory knowledge, and payer negotiation to optimize revenue recovery and ensure compliance. Why Choose AmeriProAt AmeriPro Health, you are at the heart of everything we do! Thrive here with industry-leading pay from day one, comprehensive benefits, clear career pathways, on-going training, and a supportive environment where your expertise is valued. Powered by innovative, cutting-edge technology and state-of-the-art ambulances, you will have the tools to focus on what matters: saving lives and shaping the future of healthcare. Join AmeriPro and be part of a forward-thinking team redefining EMS through innovation and a relentless commitment to excellence! Compensation & BenefitsAmeriPro supports you and your family by offering a comprehensive and competitive health and well-being benefits program.

• Competitive compensation
• Personal Time Off starting at 2 weeks and increasing with tenure
• Expansive Benefits package to include Medical, Dental, Vision, Short-term Disability, Life, Accident and Critical Illness and Hospital Indemnity
• Employer paid Basic Life and AD&D
• Employer $600 contribution to HSA with an HDHP
• 401(k) Employer Match of 50% up to first 6% of eligible compensation
• Employee Assistance Programs (EAP)
• $5,000 Tuition Reimbursement for Professional Development
• Opportunities for career Advancement
• Flexible Scheduling Options

Key Responsibilities

Key Responsibilities

• Review and resolve complex ambulance claims, aged accounts receivable, and high-value escalated accounts
• Prepare, draft, and submit professional first-level, second-level, and external appeals or payer reconsideration requests
• Analyze denial trends and identify root causes impacting reimbursement to support denial prevention workflows
• Research payer policies, LCDs, state Medicaid guidelines, and contract language related to ambulance reimbursement
• Manage escalated claims involving medical necessity, non-covered transports, Medicare/Medicaid crossovers, QMB balance billing, timely filing, and authorization disputes
• Collaborate with operations, documentation teams, coders, and leadership to obtain supporting records and improve claim outcomes
• Communicate directly with insurance representatives, provider relations, and government agencies to ensure timely resolutions
• Maintain accurate documentation of account activity within billing systems, clearinghouses, and payer portals

Physical Requirements

• Ability to work in a standard office or remote workspace environment
• Ability to stand, sit, bend, reach, and move within standard office spaces
• Ability to operate computers, billing software, clearinghouses, and standard office equipment
• Ability to function effectively in a fast-paced, deadline-driven, and high-accountability environment
• Ability to maintain concentration and focus while managing repetitive analytical tasks and high-volume data entry

Qualifications

QualificationsRequired:

• High school diploma or equivalent
• Minimum of 3 years of direct ambulance billing and claims experience
• Proven experience handling Medicare, Medicaid, and Commercial ambulance claims
• Deep knowledge of ambulance medical necessity requirements, HIPAA compliance, and payer regulations
• Strong experience with appeals, denials management, and reimbursement research
• Demonstrated ability to interpret EOBs, remits, payer correspondence, and fee schedules
• Exceptional written communication and analytical skills for drafting formal appeals

Preferred:

• Certified Ambulance Coder (CAC) credential
• Experience developing training materials, workflows, and best practices for revenue cycle management
• Advanced proficiency with EMS-specific billing systems and clearinghouses
• Good working knowledge of common physical illnesses, obvious symptoms, and medical terminology

Certification & Licensure Requirements

• Current state driver’s license
• Certified Ambulance Coder (CAC) designation (preferred at hire, or willing to obtain)

Equal Opportunity Employer StatementIt is the policy of AmeriPro Health to provide equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, gender identity, sex, sexual orientation, national origin, age, physical or mental disability, genetic information, marital status, status as a veteran or military service, or any other characteristic protected by applicable federal, state, or local civil rights laws. AmeriPro Health supports veterans, provides reasonable accommodations for individuals with a disability. We are committed to maintaining a workplace free from harassment/retaliation. #AmeriPro

Shift

Mon-Fri Weekends & Nights (as required by business need)