Third Party Billing Rep

Overview Guidehouse is a leading global provider of consulting services to the public sector and commercial markets, with broad capabilities in management, technology, and risk consulting. By combining our public and private sector expertise, we help clients address their most complex challenges and navigate significant regulatory pressures focusing on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that help our clients outwit complexity and position them for future growth and success. The company has more than 12,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit Responsibilities Under general supervision and according to established policies and procedures, performs a variety of duties related to the Third Party Accounts recovery function of the MSO. Such duties may include, but are not limited to, the following: Obtains claim status Receives and reviews denials Performs data entry of charges into various carrier systems Resubmits reviews and corrected claims and supporting documentation as needed Communicates with third party payors to obtain payment Communicates issues to management in a timely manner Performs other duties as requested by supervisor Works support functions assigned by Supervisor/Manager (i.e.: claim edits, audit trails): Works ETM returns, tickler returns and transfers daily Works claim edits and audit trails daily Work correspondence workbasket daily Works paper claims daily Weight x Rating = Score Responsibility Number 2 40% x = Processes denials from third party payors on patient accounts Works ETM views to obtain claim status on patient accounts Retrieves medical records needed to file appeals/ reviews to carriers c) Access payor websites for on-line keying of charges Research websites for specific coding policies (i.e., Encoder, CCI edits, CMS, etc.) Research accounts related to recoupments and refunds f) High dollar invoices addressed monthly Aged receivables addressed monthly Low dollar invoices addressed monthly Weight x Rating = Score Responsibility Number 3 30% x = Performs various data entry functions to correct information to accurately process charges Verifies and corrects insurance information in registration, visit and COB and refiles claims to correct carrier Posts appropriate contractual or other adjustments utilizing the payment posting function Enters various charge entry data utilizing the charge entry function Creates case and links appropriate invoices using case management function Weight x Rating = Score Responsibility Number 4 15% x = Provides responses in a timely manner by using available resources Receives incoming and outgoing calls and addresses billing inquiries from third party payors and MSO divisions Responds to work related emails in a timely manner Attends team meetings and other MSO functions Completes all required training and any ongoing educational needs Qualifications Required: High School Diploma or equivalent. Good written and oral communication skills. Basic computer skills. Preferred: 1-3 years of related experience in insurance billing, customer service related field or educational equivalent. General knowledge of payer specific or medical specialty billing. Good organizational and analytical skills. Knowledge of ICD-9 and CPT coding Additional Requirements The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described. Due to our contractual requirements, to be eligible for this role, you must be fully COVID-19 vaccinated at time of hire. Disclaimer About Guidehouse Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [Click Here to Email Your Resumé]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee. Rewards and Benefits Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace. Benefits include: Medical, Rx, Dental & Vision Insurance Personal and Family Sick Time & Company Paid Holidays Position may be eligible for a discretionary variable incentive bonus Parental Leave and Adoption Assistance 401(k) Retirement Plan Basic Life & Supplemental Life Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts Short-Term & Long-Term Disability Tuition Reimbursement, Personal Development & Learning Opportunities Skills Development & Certifications Employee Referral Program Corporate Sponsored Events & Community Outreach Emergency Back-Up Childcare Program IndeedsponsoredRequired: High School Diploma or equivalent. Good written and oral communication skills. Basic computer skills. Preferred: 1-3 years of related experience in insurance billing, customer service related field or educational equivalent. General knowledge of payer specific or medical specialty billing. Good organizational and analytical skills. Knowledge of ICD-9 and CPT codingUnder general supervision and according to established policies and procedures, performs a variety of duties related to the Third Party Accounts recovery function of the MSO. Such duties may include, but are not limited to, the following: Obtains claim status Receives and reviews denials Performs data entry of charges into various carrier systems Resubmits reviews and corrected claims and supporting documentation as needed Communicates with third party payors to obtain payment Communicates issues to management in a timely manner Performs other duties as requested by supervisor Works support functions assigned by Supervisor/Manager (i.e.: claim edits, audit trails): Works ETM returns, tickler returns and transfers daily Works claim edits and audit trails daily Work correspondence workbasket daily Works paper claims daily Weight x Rating = Score Responsibility Number 2 40% x = Processes denials from third party payors on patient accounts Works ETM views to obtain claim status on patient accounts Retrieves medical records needed to file appeals/ reviews to carriers c) Access payor websites for on-line keying of charges Research websites for specific coding policies (i.e., Encoder, CCI edits, CMS, etc.) Research accounts related to recoupments and refunds f) High dollar invoices addressed monthly Aged receivables addressed monthly Low dollar invoices addressed monthly Weight x Rating = Score Responsibility Number 3 30% x = Performs various data entry functions to correct information to accurately process charges Verifies and corrects insurance information in registration, visit and COB and refiles claims to correct carrier Posts appropriate contractual or other adjustments utilizing the payment posting function Enters various charge entry data utilizing the charge entry function Creates case and links appropriate invoices using case management function Weight x Rating = Score Responsibility Number 4 15% x = Provides responses in a timely manner by using available resources Receives incoming and outgoing calls and addresses billing inquiries from third party payors and MSO divisions Responds to work related emails in a timely manner Attends team meetings and other MSO functions Completes all required training and any ongoing educational needs

Created: 2025-11-15