PB Epic Claim Processor

The PB Epic Claim Processor 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
• PB Epic E.H.R Experience Required.
• FULL Cycle RCM 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.