TruBridge

Claims Specialist

• Acting as a liaison for hospitals and clinics using TruBridge’s complete business office services
• Billing insurance companies for all hospital, hospital-based physician and clinic bills
• Pursuing collection of all claims until payment is made by insurance companies
• Preparing and submitting hospital, hospital-based physician and clinic claims to third-party insurance carriers either electronically or by hard copy billing
• Securing needed medical documentation required or requested by third party insurances
• Following up with third-party insurance carriers on unpaid claims till claims are paid or only self-pay balance remains
• Processing 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
• Maintaining quality customer service by following company policies and procedures as well as policies and procedures specific to each customer
• Updating job knowledge by participating in company offered education opportunities
• Protecting customer information by keeping all information confidential
• Processing miscellaneous paperwork
• Ability to work with high profile customers with difficult processes
• Ensuring 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)
• Responding to inquiries by insurance companies
• Denial Management
• Meeting with Billing Manager/Supervisor to discuss and resolve reimbursement issues or billing obstacles
• Reviewing late charge reports and filing corrected claims or writing off charges as per client policy
• Reviewing reports identifying readmissions or overlapping service dates and ignoring, merging, or split-billing according to the payer’s rules and the client’s policy
• Reviewing credit reports, resolving credits belonging to a payer when able, and submitting a listing of credits to the facility as required by the payer

Meditech Claims Processor – UB-04, HCFA 1500

Medical Billing and Coding

• Conduct compliance audits on medical billing functions performed by TruBridge employees or TruBridge contracted or sub-contracted staff.
• Provides informal guidance to billers and solves straightforward problems.
• Discusses findings with Compliance Consultant and/or Department Leader to identify needs for corrective and preventative action.
• Refers to Federal, State, and payer-specific billing guidelines as well as internal policies and procedures when conducting these audits.
• Conduct audits upon claims as prescribed in the Medical Billing and Coding Compliance audit plan.
• Document audit findings within the tool developed for such; discuss questions with the department’s Billing and Coding Compliance Consultant and/or the Department Leader.
• Suggest possible policies and procedures or educational materials to be developed, or possible changes to be made.

Medical Billing and Coding Compliance Analyst

Support Engineer

• Assist internal and external customers with technical support and assistance regarding electronic billing software needs
• Machine Readable File and Shoppable Services Support
• Eligibility Verification Support for use with RCM or another Third Party EHR
• Good Faith Estimate Letter creation and modifications
• PLE Profile modeling and review
• Answer incoming call queue and monitor a manual support queue
• Research and special projects assigned by management
• Assist customers with ongoing support and troubleshooting for eligibility and Patient Liability Estimator applications

Meditech Claims Processor – UB-04, HCFA 1500

Medical Billing and Coding Compliance Analyst

Technical Support Specialist