DQA Specialist

Priority Ondemand; Conyers (GA); On-site; USD 50,000 - 65,000; Full time

Job summary

Priority Ondemand is seeking an Insurance & QA Specialist in Conyers, GA. This office-based role focuses on EMS billing pre-authorization and data quality assurance with regular interaction with field staff and external partners.

responsibilities include verifying eligibility, obtaining prior authorizations, and ensuring documentation supports medical necessity. The position requires accuracy, CMS knowledge, and strong communication skills.

Qualifications

• High school diploma or equivalent required; Associate's degree in healthcare administration, billing/coding, or related field preferred.
• Minimum 1–2 years of experience in medical billing, insurance, or healthcare administration.
• EMT or Paramedic certification (active or prior) a plus but not required.

Responsibilities

• Verify patient insurance eligibility, benefits, and coverage for EMS transports.
• Initiate and obtain prior authorizations for scheduled transports (e.g., non-emergency ambulance, repetitive transports).
• Coordinate approvals with hospitals, nursing facilities, insurance companies, and case managers to ensure timely processing.
• Document all communications, approvals, and denials in the patient record/billing system.
• Follow up on pending authorizations to prevent denials and support appeals as needed.
• Review PCRs for accuracy, completeness, and compliance with CMS/state EMS regulations.

Skills

EMS operations knowledge

Medical terminology

Insurance billing practices

CMS requirements

Attention to detail

Communication skills

ePCR proficiency

Billing systems proficiency

Multitasking

Fast-paced environment

Education

High school diploma or equivalent

Associate's degree in healthcare administration, billing/coding, or related field

EMT or Paramedic certification (active or prior) a plus but not required

Tools

ePCR software

Billing systems

Job description

Job Details: Job Location: Conyers, GA 30094, Position Type: Central EMS, Job Category: Billing / Finance, Position Summary

Essential Duties & Responsibilities

Insurance Pre-Authorization Duties:

• Verify patient insurance eligibility, benefits, and coverage for EMS transports.
• Initiate and obtain prior authorizations for scheduled transports (e.g., non-emergency ambulance, repetitive transports).
• Communicate with hospitals, nursing facilities, insurance companies, and case managers to coordinate approvals.
• Document all communications, approvals, and denials in the patient record/billing system.
• Follow up on pending authorizations to ensure timely processing and prevent claim denials.
• Work with billing staff to resolve authorization-related denials or appeals.

Data & Quality Assurance Duties:

• Review PCRs for accuracy, completeness, and compliance with company policies, CMS, and state EMS regulations.
• Ensure documentation supports medical necessity and aligns with billing/coding standards.
• Provide feedback to field crews on documentation errors, omissions, or opportunities for improvement.
• Assist in monitoring trends in documentation deficiencies and develop targeted education or corrective action.
• Maintain logs, reports, and metrics on QA/QI activities for internal compliance tracking.
• Support audits and compliance reviews by preparing requested records and reports.

Working Conditions

• Office-based role with frequent computer and phone use.
• Occasional interaction with field staff and attendance at QA meetings.
• Standard weekday schedule with potential for flexible or extended hours based on operational needs.

Qualifications: Knowledge, Skills, & Abilities

• Knowledge of EMS operations, medical terminology, and insurance billing practices.
• Familiarity with CMS medical necessity requirements and payer authorization processes.
• Strong attention to detail with the ability to identify documentation inconsistencies.
• Excellent communication skills to interact with insurance representatives, healthcare facilities, and EMS field staff.
• Proficiency in electronic patient care reporting (ePCR) and billing systems.
• Ability to manage multiple tasks, meet deadlines, and work in a fast-paced environment.

Education & Experience Requirements

• High school diploma or equivalent required; Associate's degree in healthcare administration, billing/coding, or related field preferred.
• Prior experience in EMS billing, insurance authorization, or healthcare quality assurance strongly preferred.
• EMT or Paramedic certification (active or prior) a plus but not required.
• Minimum 1-2 years of experience in medical billing, insurance, or healthcare administration.