Job Family:

Travel Required:

Clearance Required:

The Medical Biller - Hospital Commercial Biller is expected to perform all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims.  Must work with other departments to facilitate the meeting of both departmental and facility goals and objectives. Demonstrates an ability to find solutions to problems and keeps management informed of patterns regarding billing edits, compliance issues, payments and or other issues with specific payers.

Has an extensive knowledge of billing requirements mandated by payers and / or governmental regulations.  This position will perform any and all related job duties as assigned.

The Commercial Medical Biller will be working a Hybrid schedule two days in the San Marcos, CA office and three days from home.

Essential Job Functions

• Hospital Billing Emphasis

• Correcting and billing electronic and hardcopy claims

• Submits Adjusted claims

• Provides Follow-up Billing

• Prepares Billing Reconciliation

Duties and Responsibilities

• Performs daily download and reconciliation of claims from patient accounting system to electronic billing system.

• Transmits or releases claims at a minimum daily.

• Works all assigned claims daily by resolving edits, validating claim, or placing on departmental hold by reason.

• Follows-up on all assigned held claims or unreleased claims.

• Bills claims via electronic billing system.

• Reviews same day and 72 hour admission report to determine if accounts needed to be combined.

• Ensures all address changes and or plan changes are forwarded to the appropriate people so the integrity of the insurance master is maintained.

• Files adjusted billings based on audits and or changes in diagnosis or DRG.

• Updates patient accounts with corrected demographic or insurance information.

• Works all rejection and payer audit reports within 48 hours of receipt taking whatever action may be required to obtain account resolution.

• Monitors all denials for trends and issues and reports finding to supervisor.

• Bills or re-bills as necessary.

• Ensures hospital is in compliance with all state and federal rules and regulations both billing and HIPAA.

• Assigned special projects will be completed within the time frames given.

• Appropriately documents electronic billing system and/or patient accounting system.

• Attends training sessions and seminars offered by the Hospital and Third Party Payers.

• Handles all customer calls both internal and external in a professional and courteous manner.

• Returns calls and emails as soon as possible, but must be returned within 24 hours.

• Follows the mission statement and values established by the facility.

What You Will Need:

• High School Diploma / GED or 3 years of relevant equivalent experience in lieu of diploma / GED.

• 0-2+ years working within the following sectors: healthcare, insurance, business, finance or customer service.

• Working knowledge can be of the following: insurance claims, billing, coding, follow-up, finance, accounting or customer service related responsibilities.

What Would Be Nice To Have:

• Previous billing background.

• Emphasis in hospital billing

• Excellent communication and interpersonal skills.

• Experience with Excel and Word.

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What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Tuition Reimbursement, Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Corporate Sponsored Events & Community Outreach

• Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or [email protected].  Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse.  Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact [email protected]. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.