SUPERVISED BY: Directly by the DQA Supervisor
Indirectly by the General Manager, Managers, Priority Billing Services

 

EMPLOYEES SUPERVISED: None

SUMMARY DESCRIPTION: The DQA Representative is responsible for ensuring that 
information and documentation required for proper billing of medical claims is obtained and present for 
all billable events for an assigned area. 

 

DESCRIPTION OF DUTIES:
➢ Demonstrates knowledge, understanding and compliance of company policies and 
procedures.

➢ Demonstrates knowledge and understanding of (and compliance with) Federal, State and 
local laws, rules, regulations, and guidelines as they pertain to reimbursement, collections, 
and compliance.
➢ Demonstrates complete knowledge of proper billing, coding and posting procedures.
➢ Ensure security of buildings and all other company property
➢ Performs daily appropriate housekeeping duties.
➢ Ability to work as a team member. 
➢ Complete and maintain appropriate training, certification and licensure for their position.
➢ Maintain a high level of customer service when dealing with patients, patient families, coworkers, clients, other healthcare providers and the general public.
➢ Notify DQA Supervisor of any lapses in documentation resulting in less than full compliance 
with compliance and HIPAA standards. 
➢ Maintains security and privacy of all company and patient information at all times in 
accordance HIPPA and all other local, state and federal regulations.
➢ Is responsible for keeping billing and patient care records secure in accordance with proper 
HIPAA and document retention standards.
➢ Reports to assigned shifts on time and properly groomed in appropriate business attire.
➢ At all times sets an example of professionalism and places customer service, compliance 
and safety above all else.
➢ Notifies DQA Supervisor of any questions, concerns or issues regarding billing, collections 
or compliance matters.
➢ Work closely with Operations and Dispatch Management and Personnel to ensure timely, 
accurate and complete information and documentation is available to be submitted for 
proper billing services.
➢ Thoroughly evaluate all documentation received from Operations Personnel (example 
PCRs, PCSs), Dispatch Personnel (example: CAD records, call types, priorities), and 
external customers (example: insurance and demographic information) and ensure any 
shortcomings or discrepancies are addressed prior to submitting documentation and 
information to the billing office. Should ensure that all items listed on the DQA Key Data 
Point Review Sheet are reviewed, present and accurate prior to submission.
➢ Timely process assigned work and appropriately forward information and documentation to 
the billing office using the assigned workflow options.
➢ Perform other duties related to DQA or as assigned by management.

 

PHYSICAL STRENGTH REQUIRED:
1. Must be able to sit, stand, and/or walk for extended periods.
2. Ability to use a variety of Office Equipment.
3. Ability to lift and maneuver 35lbs. without difficulty. 
4. The ability to reach, push, and pull.
5. The ability to use a computer keyboard and write for extended periods of time.
6. The ability to complete all job duties. 

 

ENVIRONMENTAL CONDITIONS: Office Environment

KNOWLEDGE, SKILLS AND ABILITIES:
1. Ability to operate a variety of office equipment. 
2. Ability to communicate effectively in stress situations and to read and understand written 
and verbal instructions.
3. Ability to organize tasks and insure timely completion of all projects.
4. Ability to communicate with customers and maintain excellent customer relations.

MINIMUM REQUIREMENTS:
1. High School Diploma
2. Related experience (Preferred)
3. Must have the ability to properly perform job responsibilities 

 

SPECIAL REQUIREMENTS:
1. Working knowledge of Medicare/Medicaid/ and Third Party Insurance guidelines for 
Ambulance Service payment preferred.
2. Strong analytical and reasoning skills.
3. Well-organized, team player.
4. Satisfactory communication skills.

JOB RESPONSIBILITIES RELATED TO PATIENT PRIVACY:
• The incumbent is expected to protect the privacy of all patient information in accordance 
with the Company’s privacy policies, procedures, practices, as required by federal and 
South Carolina law, and in accordance with general principles of professionalism as a 
health care provider. Failure to comply with the Company’s policies and procedures on 
patient privacy may result in disciplinary action up to and including termination of 
employment or association with Medshore Ambulance Service.
• The incumbent may access protected health information and other patient information 
only to the extent that is necessary to complete assigned job duties. The incumbent 
may only share such information with those who have a need to know specific patient 
information you have in your possession to complete their job responsibilities related to 
treatment, payment or other company operations.
• The incumbent is encouraged and expected to report, without the threat of retaliation, 
any concerns regarding the Company’s policies and procedures on patient privacy and 
any observed practices in violation of that policy to the Chief Compliance & Professional 
Standards Officer.
• The incumbent is expected to actively participate in Company privacy training and is 
required to communicate privacy policy information to coworkers, students, patients and 
others in accordance with Company policy. 

EQUAL EMPLOYMENT OPPORTUNITY
Medshore Ambulance Service is an Equal Opportunity Employer and welcomes applications 
from all qualified applicants. Medshore Ambulance Service does not discriminate on the basis 
of race, religion, sex, national origin, age, marital status, sexual orientation, medical condition or 
disability. Medshore Ambulance Service will make reasonable accommodations in compliance 
with the Americans with Disabilities Act of 1990.

DRUG/ALCOHOL FREE WORK ENVIRONMENT:
Medshore Ambulance Service maintains a Drug and Alcohol -Free Work Environment. In 
accordance with Medshore Ambulance Service Policies & Procedures, employees are subject 
to Drug/Alcohol Screening as a condition of employment.

DISCLAIMER:
The information provided in this description has been designed to indicate the general nature 
and level of work performed by incumbents within this job. It is not designed to be interpreted, 
as a comprehensive inventory of all duties, responsibilities, qualifications and working 
conditions required of employees, assigned to this job. Management has sole discretion to add 
or modify duties of the job and to designate other functions as essential at any time. This job 
description is not an employment agreement or contract