The UB-04 Facility Claims Processor - Meditech 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.
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 and professional claim billing
- Meditech E.H.R Experience Required.
- 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.