#25-242 - Ambulance Compliance Specialist

The Ambulance Compliance Specialist is responsible for ensuring accurate and compliant ambulance billing documentation while maintaining clinical quality assurance in patient care and adherence to established protocols. This role involves auditing Patient Care Reports (PCRs) for completeness and accuracy, ensuring that all documentation complies with relevant regulations, and preparing billing reports that include necessary supporting documents and pertinent information.

As a member of a collaborative team, the specialist ensures the accuracy of clinical documentation. They communicate strategies for quality improvement to EMS crews and supervisors and are responsible for providing training and feedback to enhance documentation practices among EMS personnel. Additionally, this role includes acting as a liaison between our organization and the Arizona Department of Health Services (ADHS), focusing on ensuring compliance with state standards and regulations, scheduling inspections, and maintaining adherence to state guidelines for ambulance services.

Position Essential Functions

● Audit Patient Care Reports (PCRs): Conduct thorough reviews of electronic patient care reports for completeness and accuracy, ensuring they comply with established protocols
● Ensure Compliance: Verify that all documentation adheres to federal and state regulations, including CMS and HIPAA guidelines.
● Identify and Resolve Discrepancies: Investigate and correct errors in documentation, obtain necessary signatures, and follow up on missing information.
● Reviews Patient Care reports to verify that all correct billing information is obtained to produce an accurate bill, including patient demographics, facility face sheets, and PCS forms.
● Conduct QA Reviews: Perform internal audits to identify trends in documentation errors, track key performance indicators and report findings.
● Provide Feedback and Training: Create error reports and offer training sessions to EMS crews to enhance overall documentation practices.
● Maintain Software and Systems: Utilize EMS and billing software, as well as electronic patient care reporting systems for daily operations.
● Support Billing Operations: Collaborate with the billing department to address claim denials and resolve inquiries from patients and insurance providers.
● Serve as the primary liaison between the organization and ADHS, ensuring clear communication and collaboration.
● Monitor and interpret regulatory standards and requirements related to ambulance transport.
● Schedule and oversee compliance inspections for ambulance services, ensuring all vehicles and operations meet state standards.
● Prepare and maintain documentation related to inspections, compliance reports, and communications with regulatory agencies.
● Provide guidance and training to staff on compliance standards and best practices in ambulance operations.
● Implement corrective action plans in response to any compliance issues or discrepancies identified during inspections.
● Stay updated on changes in legislation and regulations that may affect ambulance transport and communicate these changes to relevant staff.
● Develop and maintain strong relationships with regulatory agencies and other stakeholders to advocate for the organization’s interests.
● This position may require travel to various locations for inspections and meetings.

Position Qualifications
Required

● high school diploma or GED
● Strong understanding of ambulance transport regulations and standards set by the state
● proficiency in medical terminology within an ambulance context

Preferred (certifications must be obtained within first year of employment)
● Bachelor’s degree in public health, emergency management, or a related field

● At least one year of billing experience in an ambulance setting

● NREMT or Arizona Certified Paramedic certification (Registered Nurses RNs or LPNs may also be considered)

● NAAC Certified Ambulance Coder (CAC)

● NAAC Certified Ambulance Documentation Specialist (CADS)

● NAAC Certified Professional Coder (CPC)

Position Conditions
● prolonged periods of sitting at a desk and working on a computer

Position Disclaimer
This position description in no way states or implies that these are the only duties to be performed by the employee occupying this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties required by their supervisor. This document provides an overview of the position currently available and is not an employment contract. RMF reserves the right to modify position responsibilities or position descriptions at any time. Employment with RMF is at-will and either party can terminate the employment relationship at any time with or without cause and with or without notice within the confines of federal and state law.

RMF provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.