Director of EMS Quality & Billing Strategy
About this role
We're seeking an exceptional leader to drive the intersection of clinical quality and revenue optimization for our AI-powered EMS documentation platform. This is a unique opportunity to shape how thousands of EMS providers nationwide improve their documentation quality while maximizing reimbursement.
As our Director of EMS Quality & Billing Strategy, you'll be the bridge between clinical excellence and financial sustainability. You'll design and implement QA/QI programs that not only meet regulatory requirements but actively improve patient care documentation. Your deep understanding of EMS billing will help our AI models catch revenue opportunities while ensuring compliance.
This role requires someone who has lived and breathed EMS operations - someone who understands the challenges of getting a clean PCR at 3 AM and the frustration of claim denials. You'll work directly with our engineering team to translate these real-world experiences into product features that make a difference.
You'll be joining at a pivotal moment as we scale from hundreds to thousands of transports daily. Your expertise will directly impact our product roadmap, customer success, and the financial health of EMS agencies across the country.
What you'll do
- Design and oversee comprehensive QA/QI programs aligned with NEMSQA benchmarks and state requirements
- Lead product strategy for billing optimization features, ensuring compliance with CMS, Medicare Part B, and commercial payer requirements
- Develop and implement PDSA cycles and Six Sigma methodologies to continuously improve documentation quality and first-pass acceptance rates
- Partner with engineering to translate complex billing rules (medical necessity, PCS, ABN requirements) into scalable product features
- Create and maintain compliance frameworks for HIPAA, OIG requirements, CMS Ambulance Fee Schedule, ET3, and state EMS regulations
- Lead customer discovery sessions, including ride-alongs and workflow analysis, to identify product opportunities
- Build and mentor a team of QA specialists and billing experts as we scale
- Develop training materials and best practices for customer success teams
- Prepare for and manage external audits (Medicare RAC, MAC, CERT)
- Present product vision and strategy to executive leadership, investors, and key customers
- Analyze data from multiple ePCR and billing platforms to identify optimization opportunities
- Collaborate with AI/ML teams to improve documentation scoring and claim scrubbing algorithms
What we're looking for
- 8+ years end-to-end EMS revenue cycle experience, with at least 3 years directing QA/QI or billing teams
- Hands-on experience designing QA/QI programs aligned to NEMSQA or state benchmarks
- Proven track record using PDSA or Six Sigma techniques to improve clinical documentation and first-pass acceptance rates
- Deep expertise in CMS Medicare Part B, Medicaid, and commercial EMS billing rules
- Comprehensive knowledge of medical necessity, PCS, ABN, ICD-10, CPT/HCPCS, and 837/835 workflows
- Demonstrated compliance leadership with HIPAA, OIG, CMS regulations, and state EMS statutes
- High proficiency with at least two major ePCR/billing platforms (ESO, ImageTrend, Zoll RescueNet, QuickMedClaims, etc.)
- Experience with data warehouses and BI tools (Tableau, Power BI, or Looker)
- Ability to write SQL queries or work with structured data exports for analytics
- Track record of translating EMS workflows into product requirements and roadmaps
- Strong executive-level presentation and communication skills
- Current NAAC Certified Ambulance Coder (CAC), CACO, CPAT, or equivalent certification
- Bachelor's degree in Healthcare Administration, Business, Informatics, Paramedicine, or related field
Nice to have
- Current or former EMT-P/EMT-B license
- Six Sigma Green/Black Belt or Lean certification
- Experience on NEMSQA, CAAS, or NAEMT committees
- Familiarity with HL7, FHIR, CAD integrations, and firehouse data feeds
- Experience partnering with data science teams on NLP or predictive models
- Previous startup or SaaS experience in high-growth environments
- Public speaking experience at industry conferences (Pinnacle, AAA, ZOLL Summit)
- Advanced degree or MBA
- Experience with ET3 program implementation
- Knowledge of value-based care models in EMS
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