Company Overview
Guidehouse is a global consulting firm offering advisory, technology, and managed services to both commercial and public sectors. Designed to support industries such as national security, financial services, healthcare, energy, and infrastructure, Guidehouse redefines traditional consulting models with its agility, expertise, and scale. The firm delivers technology-driven, results-focused solutions that empower clients to drive innovation, enhance resilience, and achieve sustainable growth. Committed to excellence and client success, Guidehouse’s team of over 18,000 professionals partners with industry 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 managing 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 objectives are met while identifying and resolving billing-related issues. Additionally, you will keep management informed about trends in billing edits, compliance concerns, payment issues, and payer-specific challenges.
A strong understanding of billing regulations set by payers and government entities is essential for this role. You may also be assigned additional related responsibilities as needed.
This position follows a hybrid work schedule, requiring two days in the El Segundo office and three days working remotely.
Essential Job Functions – Hospital Billing Focus
- Process and correct 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
- Review and resolve claim edits, validate claims, or place them on departmental hold with a specified reason
- Follow up on all 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 merged
- 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 rejections and payer audit reports within 48 hours to ensure timely resolution
- Monitor and report denial trends and issues 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
- 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
- 0-2+ years of experience in healthcare, insurance, business, finance, or customer service
- Basic working knowledge in 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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