Epic Resolute - Profee Biller

TruBridge; United States; On-site; USD 52,000 - 75,000; Full time

Job summary

TruBridge is seeking an Epic Resolute - Profee Biller to manage full-cycle (claims & denials) Profee billing for hospitals and clinics for a Alabama-based client. You will prepare, submit, and follow up on claims; secure documentation; handle denials; and ensure timely, accurate processing in a HIPAA-compliant environment.

You will work with insurance payers to maximize reimbursement, review EOBs, and resolve issues with internal teams to meet production and quality standards.

Qualifications

• 3 years of recent Full-Cycle Physician/Profee billing experience.
• Recent experience working with Epic PB is REQUIRED.
• Full-cycle claims processing (claim submission & follow-up) experience processing Profee claims.
• 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.

Responsibilities

• Prepares and submits clinic claims to third-party insurance carriers either electronically or by hard copy billing for claim submission.
• 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.
• Mantains 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.

Skills

Communication

Attention to detail

Problem solving

Tools

Epic PB

Job description

The Epic Resolute - Profee Biller (PB) position is responsible for FULL-CYCLE (claims & denials) claims billing for hospitals and clinics using TruBridge’s complete business office services. They work closely with our client, an Alabama-based family practice bill insurance companies for all their clinic claims (Profee). They pursue collection of all claims until payment is made by insurance companies; and perform other work associated with the billing process.

These Goals and objectives are not to be construed as a complete statement of all duties performed; employees will be required to perform other job related duties as required. Goals and objectives are subject to change.

All activities must be in compliance with Equal Employment Opportunity laws, HIPAA, ERISA and other regulations, as appropriate.

Essential Functions:

In addition to working as prescribed in our Performance Factors specific responsibilities of this role include:

• Prepares and submits clinic claims to third-party insurance carriers either electronically or by hard copy billing for claim submission.
• 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.

Education/Experience/Certification Requirements

• 3 years of recent Full-Cycle Physician/Profee billing experience
• Recent experience working with Epic PB is REQUIRED
• Full-cycle claims processing (claim submission & follow-up) experience processing Profee claims
• 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.