Claims Billing Specialist

Job Summary:

The Claims Billing Specialist position is responsible for acting as a liaison for hospitals and clinics using TruBridge’s complete business office services. They work closely with TruBridge management and hospital employees to bill insurance companies for all hospital, hospital-based physician and clinic bills. They pursue collection of all claims until payment is made by insurance companies; and perform other work associated with the billing process.

These Goals and objectives are not to be construed as a complete statement of all duties performed; employees will be required to perform other job related duties as required.  Goals and objectives are subject to change.

All activities must be in compliance with Equal Employment Opportunity laws, HIPAA, ERISA and other regulations, as appropriate. 

Essential Functions:

In addition to working as prescribed in our Performance Factors specific responsibilities of this role include:

• Prepares and submits hospital, hospital-based physician and clinic claims to third-party insurance carriers either electronically or by hard copy billing.
• Secures needed medical documentation required or requested by third party insurances.
• Follows up with third-party insurance carriers on unpaid claims till claims are paid or only self-pay balance remains.
• Processes rejections by either making accounts private or correcting any billing error and resubmitting claims to third-party insurance carriers.
• Responsible for consistently meeting production and quality assurance standards.
• Maintains quality customer service by following company policies and procedures as well as policies and procedures specific to each customer.
• Updates job knowledge by participating in company offered education opportunities.
• Protects customer information by keeping all information confidential.
• Processes miscellaneous paperwork.
• Ability to work with high profile customers with difficult processes.
• May regularly be asked to help with team projects.
• Ensure all claims are submitted daily with a goal of zero errors.
• Timely follow up on insurance claim status.
• Reading and interpreting an EOB (Explanation of Benefits).
• Respond to inquiries by insurance companies.
• Denial Management.
• Meet with Billing Manager/Supervisor to discuss and resolve reimbursement issues or billing obstacles.
• Review late charge reports and file corrected claims or write off charges as per client policy.
• Review reports identifying readmissions or overlapping service dates and ignore, merge, or split-bill according to the payer’s rules and the client’s policy.
• Review credit reports, resolve credits belonging to a payer when able, and submit a listing of credits to the facility as required by the payer.

Minimum Requirements:

Education/Experience/Certification Requirements

• 3 years of recent Critical Access or Acute Care facility billing or 3 years of physician billing experience or hospital billing experience.
• Medicare Billing Experience preferred.
• Computer skills.
• Experience in CPT and ICD-10 coding.
• Familiarity with medical terminology.
• Ability to communicate with various insurance payers.
• Experience in filing claim appeals with insurance companies to ensure maximum reimbursement.
• Responsible use of confidential information.
• Strong written and verbal skills.
• Ability to multi-task.