TruBridge

• Prepare and submit hospital claims to third-party insurance carriers • Secure needed medical documentation required by third party insurances • Follow up on unpaid claims • Process rejections and resubmit claims • Meet production and quality assurance standards • Maintain quality customer service • Respond to inquiries by insurance companies • Review late charge reports and file corrected claims

• Responsible for the timely follow-up and resolution of insurance claims. • Analyze A/R data and perform claim status checks. • Handle denials and maintain compliance with U.S. healthcare billing and regulatory requirements. • Optimize cash flow and support overall revenue cycle performance. • Review and interpret Explanation of Benefits (EOBs), authorizations, and medical documentation. • Convert denials into payments by filing appeals or correcting claim errors.

• Acting as a liaison for hospitals and clinics using TruBridge’s complete business office services • Billing insurance companies for all hospital, hospital-based physician and clinic bills • Pursuing collection of all claims until payment is made by insurance companies • Preparing and submitting hospital, hospital-based physician and clinic claims to third-party insurance carriers either electronically or by hard copy billing • Securing needed medical documentation required or requested by third party insurances • Following up with third-party insurance carriers on unpaid claims till claims are paid or only self-pay balance remains • Processing 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 • Maintaining quality customer service by following company policies and procedures as well as policies and procedures specific to each customer • Updating job knowledge by participating in company offered education opportunities • Protecting customer information by keeping all information confidential • Processing miscellaneous paperwork • Ability to work with high profile customers with difficult processes • Ensuring 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) • Responding to inquiries by insurance companies • Denial Management • Meeting with Billing Manager/Supervisor to discuss and resolve reimbursement issues or billing obstacles • Reviewing late charge reports and filing corrected claims or writing off charges as per client policy • Reviewing reports identifying readmissions or overlapping service dates and ignoring, merging, or split-billing according to the payer’s rules and the client’s policy • Reviewing credit reports, resolving credits belonging to a payer when able, and submitting a listing of credits to the facility as required by the payer

• Conduct compliance audits on medical billing functions performed by TruBridge employees or TruBridge contracted or sub-contracted staff. • Provides informal guidance to billers and solves straightforward problems. • Discusses findings with Compliance Consultant and/or Department Leader to identify needs for corrective and preventative action. • Refers to Federal, State, and payer-specific billing guidelines as well as internal policies and procedures when conducting these audits. • Conduct audits upon claims as prescribed in the Medical Billing and Coding Compliance audit plan. • Document audit findings within the tool developed for such; discuss questions with the department’s Billing and Coding Compliance Consultant and/or the Department Leader. • Suggest possible policies and procedures or educational materials to be developed, or possible changes to be made.

• Assist internal and external customers with technical support and assistance regarding electronic billing software needs • Machine Readable File and Shoppable Services Support • Eligibility Verification Support for use with RCM or another Third Party EHR • Good Faith Estimate Letter creation and modifications • PLE Profile modeling and review • Answer incoming call queue and monitor a manual support queue • Research and special projects assigned by management • Assist customers with ongoing support and troubleshooting for eligibility and Patient Liability Estimator applications

• Provide support for continued management of internal and customer-reportable investigations under HIPAA Privacy, Cardholder Data Security, and Information Security programs. • Investigate potential incidents and assist in generating internal and external reports of findings. • Maintain the inventory/log of all identified incidents. • Contribute to the assignment of corrective and preventive actions to investigations. • Conduct investigations for a subset of potential incident types. • Make initial telephone notifications to affected customers. • Compile incident data for quarterly executive reports. • Collaborate with the Cyber Security group to obtain artifacts for investigations. • Provide overall assistance to the Compliance Analyst.

• The Billing Manager is responsible for overseeing claims production, billing, follow-up, collections, and compliance with third party payer regulations. • This position is responsible for both strategic alignment and daily oversight and management of process-based revenue cycle functions. • Includes ongoing improvement to key revenue cycle indicators such as A/R days, cash collection goals and postings, etc. • Possess complete understanding of the billing/collection process to resolve complex, outstanding claims. • Ensures accounts are billed accurately and timely by providing proactive oversight and direction for billing and collections. • Provides operational oversight for the Billing Coordinator, mentoring them in their responsibilities. • Maintains current knowledge of hospital billing systems and government payer systems, including applicable federal/state laws and regulations. • Demonstrates ability to manage, train and motivate employees. • Organizes and leads efforts to maximize operational efficiency and optimize reimbursement. • Monitors denials and provides education and reporting regarding the effect of denials from their areas. • Reviews all statistical reports to monitor trends, determine operational deficiencies and implement corrective action plans as necessary. • Pro-active communication/escalation of potential claims/unbilled accounts/issues to the Director. • Exhibits excellent leadership and self-direction, good judgement in handling difficult situations and good organizational, time management, interpersonal and conflict resolution skills. • Assures that confidentiality of patient information is maintained without exception. • Attends all required meetings and activities. • Implements, and monitors the department budget.

• Review and verify patient demographic and insurance information to ensure accuracy. • Confirm that all necessary documentation and authorization are in place before submitting claims. • Review and assess medical claims for accuracy and completeness. • Identify discrepancies or missing information and rectify them promptly. • Review and update claim documentation as necessary. • Submit medical claims to insurance companies following established billing guidelines. • Utilize billing software and systems to ensure accurate and timely claim submission. • Monitor and track the status of submitted claims. • Analyze and address claim rejections promptly. • Make necessary corrections, resubmit claims, and follow up to resolve outstanding rejections or claim edits. • Stay up to date with healthcare regulations and insurance policies. • Ensure billing practices adhere to industry standards and compliance requirements, including HIPAA. • Ensure insurance coverage and eligibility. • Review each claim and adjust the incorrect information accordingly.

• 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

• Conducts quality assurance audits on TruBridge employees, or sub-contracted staff. • Present findings to the auditee. • Summarize findings, and report to Management. • Develop training materials. • Conduct presentations to audited staff for further development. • Assists in developing training plans for clients, TruBridge employees, and sub-contracted employees.