Company Overview
Guidehouse is a global consulting firm specializing in advisory, technology, and managed services for both commercial and public sectors. Designed to support industries such as national security, financial services, healthcare, energy, and infrastructure, Guidehouse challenges traditional consulting models with its agility, expertise, and scale. The firm leverages technology-driven solutions to drive innovation, resilience, and growth for its clients. Committed to excellence and client success, Guidehouse’s team of over 18,000 professionals partners with leaders to navigate complexity and implement transformative changes that shape the future.
What You Will Do
As a Medical Biller, you will be responsible for all aspects of initial and secondary billing, as well as payer audit follow-ups for both government and non-government claims. You will collaborate with various departments to ensure departmental and facility goals are met while identifying solutions to challenges. Additionally, you will keep management informed about billing edits, compliance concerns, payment issues, and payer-specific trends.
A strong understanding of billing regulations set by payers and government entities is essential for this role. You may also be assigned other related responsibilities as needed.
This position follows a hybrid work schedule, requiring time spent working both remotely and at the San Marcos, CA, or El Segundo, CA offices.
Essential Job Functions – Hospital Billing Focus
- Process and correct electronic and paper claims
- Submit adjusted claims
- Perform follow-up billing
- Prepare billing reconciliation reports
Duties and Responsibilities
- Download and reconcile claims from the patient accounting system to the electronic billing system daily
- Release or transmit claims at least once per day
- Review and resolve claim edits, validate claims, or place them on departmental hold as necessary
- Follow up on held or unreleased claims
- Submit claims through the electronic billing system
- Analyze same-day and 72-hour admission reports to determine if accounts should be combined
- Ensure address and plan changes are updated to maintain accurate insurance records
- Process adjusted billing due to audits or changes in diagnosis/DRG
- Update patient accounts with correct demographic or insurance details
- Address rejection and payer audit reports within 48 hours to ensure timely resolution
- Monitor and report denial trends and issues to the supervisor
- Re-bill claims as needed
- Ensure compliance with state and federal regulations, including billing and HIPAA requirements
- Complete assigned special projects within designated timeframes
- Maintain accurate documentation in the electronic billing and patient accounting systems
- Attend training sessions and payer seminars as required
- Handle internal and external customer inquiries professionally and courteously
- Respond to calls and emails within 24 hours
- Adhere to the facility’s mission statement and core values
What You Will Need
- High school diploma, GED, or at least three years of relevant experience in place of a diploma/GED
- 1-3+ years of experience in healthcare, insurance, business, finance, or customer service
- Working knowledge in areas such as insurance claims, billing, coding, follow-up, finance, accounting, or customer service
Preferred Qualifications
- Prior experience in medical billing
- Experience specifically in hospital billing
- Strong communication and interpersonal skills
- Proficiency in Microsoft Excel and Word
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