Billing Optimization Analyst

Med Metrix•Parsippany-Troy Hills, NJ

10d

About The Position

The Billing Optimization Analyst is the subject matter expert responsible for identifying and permanently resolving barriers to accurate and timely claim submission. The role applies knowledge of Medicare, Medicaid, managed care, and commercial payer requirements throughout the hospital claim-generation lifecycle, including edits, claim splits, bill holds, rejections, late charges, and other exceptions. The analyst independently diagnoses root causes, partners with billing, IT, operational, clinical, reimbursement, coding, and vendor teams to implement fixes, and works to prevent recurring issues. The position monitors billing performance measures and develops guidance, standard work, and education to sustain improvements and promote consistent practices. It also advises billing and client leadership on billing risks, priorities, and the financial impact of recommended changes. The employee must comply with HIPAA and information security policies, limiting access to protected health information to the minimum necessary for assigned duties. Occasional travel to client facilities may be required, and work outside normal business hours may be needed for special projects. The employee must have a smartphone or other electronic device capable of downloading applications for multifactor authentication and security. Physical duties may include moving around the work area, sitting, manual tasks, operating office equipment, extending arms, and kneeling. The role requires independent judgment, collaboration, and the ability to manage competing priorities and changing business needs. The work environment typically has minimal noise.

Requirements

Bachelor’s degree in healthcare administration, business, finance, or a related field, or an equivalent combination of education and progressive hospital billing experience.
At least 4 years of progressive hospital billing experience, including hands-on resolution of complex claims before submission and leadership of recurring billing issue resolution.
Advanced knowledge of the end-to-end institutional claim lifecycle, including claim edits, split-billing scenarios, bill holds, rejections, late charges, stop bills, and corrected or replacement claims.
In-depth knowledge of Medicare, Medicaid, managed care, and commercial payer billing rules, claim formats, and submission requirements.
Strong working knowledge of UB-04 and 837I requirements, revenue codes, bill types, condition and occurrence codes, modifiers, claim frequency codes, and payer-specific edits.
Demonstrated ability to identify root causes, lead cross-functional performance improvement initiatives, sustain results, and work independently.
Ability to analyze billing, edit, hold, and rejection data to identify trends and quantify financial impact.
Proficiency in Microsoft Office Suite.
Strong interpersonal and influencing skills, including the ability to communicate and present findings to all organizational levels, including executive leadership.
Strong problem-solving and creative skills, with the ability to exercise independent judgment and make decisions based on accurate and timely analyses.
High integrity and dependability, a strong sense of urgency, and a results-oriented approach.
Excellent written and verbal communication skills.
Ability to work outside normal business hours to support special projects.
Must possess a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes.

Nice To Haves

Experience researching claim-generation issues in Epic Resolute or a comparable patient accounting system.
Experience using clearinghouse tools, payer portals, claim scrubbers, and reporting tools.
Exposure to multiple hospitals, facilities, or payer environments.
Occasional ability to travel to client facility sites may be required.

Responsibilities

Serve as the subject matter expert for the hospital claim-generation lifecycle, from final coding and charge capture through claim creation, validation, and transmission.
Research and resolve complex billing edits, claim splits, bill holds, rejections, late charges, stop bills, and other exceptions that delay claim release.
Interpret and apply Medicare, Medicaid, managed care, and commercial payer billing requirements to determine appropriate billing approaches for complex or non-standard scenarios.
Analyze recurring claim barriers and determine root causes involving processes, system configuration, payer rules, and upstream workflows.
Lead working sessions with billing leaders and team members to review billing scenarios, present findings, and agree on resolution steps and owners.
Partner with operational, clinical, reimbursement, coding, IT, and vendor teams to design and drive improvements to edits, work queues, workflows, and escalation processes.
Monitor first-pass clean-claim rate, bill-hold days, DNFB, rejection trends, and billing throughput to confirm improvements are sustained, identify opportunities, and coordinate follow-up when results miss established targets.
Develop billing guidance, standard work, and education based on root-cause findings to prevent recurrence and promote team consistency.
Advise billing and client leadership on billing risks, priorities, and the financial impact of recommended changes.
Perform other duties as assigned.
Use, protect, and disclose patients’ protected health information only in accordance with HIPAA standards.
Comply with information security and HIPAA policies and procedures, and limit viewing of PHI to the minimum necessary for assigned duties.