At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers.
When you join Triple-S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.
Let's build healthier communities together, join now!
JOB SUMMARY
Performs the verification process of the services provided at the clinic to ensure that they can be properly billed and fully collected. Collects, organizes, and presents relevant data to resolve specific situations and, or problems in the billing cycle. Reconciles payments of checks received both electronically and manually. Works with claims and denials to ensure the clinic's goals are met. Gathers information on accounts receivable to ensure the collection of credits resulting from the services provided to the patient in accordance with the company's established policies. Notifies management of any discrepancies in the process so that corrective and preventive measures can be taken.
ESSENTIAL FUNCTIONS
- Verifies that the processed invoices are correct, identifying items such as diagnosis, referrals, contract numbers, address, deductibles, and other patient-related information.
- Validates that the invoices processed in the areas are correct in order to process claims. Corrects discrepancies found in the system.
- Transmits files and reviews acknowledgments of receipt on a daily basis.
- Identifies "superbills" that have not been billed.
- Ensures that the billing process has been correctly carried out to the provider.
- Responsible for identifying "progress notes" in the system to ensure that the procedures are consistent with those applied in the "superbills."
- Verifies "superbills" against the general audit.
- Reconciles checks received manually and, or electronically.
- Responsible for validating payment explanations and submitting adjustments for denials.
- Verifies the aging of unpaid claims by insurers and follows up on collections.
- Responsible for processing the submission of secondary plan supplements once the primary insurer has paid.
- Conducts collection efforts for unpaid patient services.
- Sends collection letters to patients for services not paid by the insurer.
- Informs patients about medical plan charges if necessary.
- Communicates with insurers once a month to verify payments in transit and notifies the Finance division.
- Adjusts non-processable balances in TRA of the rates.
Coordinates referrals and pre-authorizations with insurers as required. - Informs patients about directed care billing if necessary.
- Generates general audit reports.
- Responsible for processing invoices and sending them to insurers, either by mail, portal, and, or messenger.
- Performs general office tasks such as filing, coding, photocopying, matching invoices, and general documents.
EDUCATION
- Associate's Degree in Medical Billing
EXPERIENCE
Associate Degree from a recognized University or College in Medical Billing or at least 60 to 64 college credits with 6 months to 1 year of experience. Alternatively, 1 to 3 years of experience in the position.
LICENSES AND CERTIFICATIONS
- None required
COMPETENCIES
It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.
Equality Employment Opportunity/Affirmative Action for People with Disabilities/Veterans. Employer with E-Verify to verify the eligibility of employment of all the new employees.
We encourage Veterans and Disabled to Apply.