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 redefines traditional consulting approaches with its agility, expertise, and scale. The firm leverages technology-driven, results-focused solutions to empower clients with innovation, resilience, and sustainable growth. With a commitment to excellence and client success, Guidehouse’s team of over 18,000 professionals partners with industry leaders to navigate complexity and drive transformative change that shapes the future.
What You Will Do
As a Medical Biller, you will be responsible for handling 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 help achieve facility and departmental goals while identifying and resolving billing-related challenges. Additionally, you will keep management informed about trends in billing edits, compliance issues, payment discrepancies, and payer-specific concerns.
A thorough understanding of billing regulations set by payers and government agencies is essential for this role. Additional related responsibilities may be assigned as needed.
This position follows a hybrid work schedule, splitting time between the San Marcos, CA, or El Segundo, CA offices and remote work.
Essential Job Functions – Hospital Billing Focus
- Process and correct both electronic and paper claims
- Submit adjusted claims
- Conduct 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
- Transmit or release claims at least once per day
- Work through assigned claims daily by resolving edits, validating claims, or placing them on departmental hold as needed
- Follow up on all held or unreleased claims
- Submit claims through the electronic billing system
- Review same-day and 72-hour admission reports to determine if accounts should be merged
- Ensure all address and plan changes are forwarded appropriately to maintain accurate insurance records
- Process adjusted billings due to audits or changes in diagnosis/DRG
- Update patient accounts with corrected demographic or insurance information
- Resolve rejections and payer audit reports within 48 hours of receipt
- Identify denial trends and report findings to the supervisor
- Process billing or re-billing as necessary
- Ensure compliance with all 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
- Uphold 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
- 0-2+ years of experience in healthcare, insurance, business, finance, or customer service
- Basic knowledge of insurance claims, billing, coding, follow-up, finance, accounting, or customer service
Preferred Qualifications
- Previous experience in medical billing
- Focus on hospital billing
- Strong communication and interpersonal skills
- Proficiency in Microsoft Excel and Word