Billing Optimization Analyst

Med-Metrix•Parsippany-Troy Hills, NJ

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 expert knowledge of Medicare, Medicaid, managed care, and commercial payer requirements across 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, and operational teams to implement fixes, and ensures issues do not recur. The position analyzes billing performance and trends, leads working sessions to review complex scenarios, and collaborates with operational, clinical, reimbursement, coding, IT, and vendor teams to improve edits, work queues, workflows, and escalation processes. It develops billing guidance, standard work, and education, and advises billing and client leadership on risks, priorities, and the financial impact of recommended changes. The role must comply with HIPAA and information-security policies, using and disclosing protected health information only as permitted and limiting access to the minimum necessary. Occasional travel to client facilities may be required, as may work outside normal business hours for special projects.

Requirements

Bachelor’s degree in healthcare administration, business, finance, or a related field; an equivalent combination of education and progressive hospital billing experience will be considered.
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 at 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.

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 complex or non-standard scenarios.
Analyze recurring claim barriers and identify root causes across 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; confirm improvements are sustained, identify further opportunities, and coordinate follow-up when results do not meet 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.
Understand and comply with Information Security and HIPAA policies and procedures.
Limit viewing of protected health information to the minimum necessary to perform assigned duties.