Medical Billing Analyst

Albany Medical Center•Saratoga Springs, NY

1d•Onsite

About The Position

The Medical Billing Analyst is an intermediate billing position within the Hospital or Physicians Billing Offices for the Albany Med Health System (AMHS). This role is centered around the timely follow up needed on accounts that have already been billed but need re-billing, accounts in which the payer has not responded within the regulatory guidelines, or AMHS has received a denial that needs an immediate action and/or rebuttal. The denials assigned in this role are more intricate than others and the denial response may require a professional narrative accompanied by supporting documentation to be overturned. Some or all these areas may be the focus of the position depending on the resources needed. The incumbent must be able to prove that they have an ability to learn quickly and work independently. They will possess the ability to use payer websites to locate payer policies that may be impacting the ability for AMHS to be paid timely. The incumbent will be expected to work independently and meet production standards after the prescribed onboarding and training is concluded. Communication with peers, trainers, and leaders will also be imperative to success. This position will identify accounts that need to be placed on the payer agendas as they are not being resolved through the normal dispute process. The accounts are aging on the accounts receivable. Concentration on the AR > 60 days. Identification and communication of payer trends that are negatively impacting the overall AR. Timely and professional communication with outside departments to resolve the billing or follow-up challenges. Consistent and responsive communication with Patient Access and Coding are a must. Identification of department trends that need to be brought to Management to address with the departments. Participate as needed and at the request of leadership. These could include practices, hospital departments, as well as departments within the revenue cycle. Build an understanding of expected reimbursement on the accounts to ensure correct payments are received. Build an understanding of the reports provided by leadership as it pertains to the assigned task or assignment.

Requirements

High School Diploma/G.E.D. - required
Ability to work independently and within a team
Excellent verbal and written communication skills.
Ability to communicate with internal peers and leadership
Demonstrates an ability to learn and understand instruction
Ability to effectively prioritize and execute tasks in a high-volume atmosphere.
Microsoft Office and website knowledge
Equivalent combination of relevant education and experience may be substituted as appropriate.

Nice To Haves

Associate's Degree - preferred
Prior office experience - preferred
Medical Billing or claims knowledge - preferred
CCS-Certified Coding Specialist
Certified Inpatient Coder (CIC) or Certified Outpatient Coder (COC) Upon Hire - preferred

Responsibilities

Resolve the more intricate billing edits as assigned.
Follow up on the No Response WQs as assigned.
Communicate with the payer via phone, email, or website platforms as needed.
Ability to locate denial or remittances via the payer websites as needed.
Respond to denials received on accounts as assigned.
Collaborate professionally internally or with external departments when needed to resolve the edit or denial.
Identify and present the payer trends amongst the claims that are editing for similar reasons.
Identify payer trends within the denials and work with leaders to mitigate those denials where possible.
Proper and detailed notation of actions taken on the account.
Payer Website navigation as needed to obtain information.
Review, understand, and locate payer policy guidelines as required.
Ability to locate claim adjudication details with the supporting documentation.
Proficient use of Epic, On Base, and other platforms as needed.
Ability to work independently and under time constraints and deadlines and with minimal supervision.
Able to prioritize workload in an effective manner.
Begin to articulate possible avenues to resolve claim challenges.
Meet daily/weekly productivity standards with acceptable QA results.
Identify accounts that need to be placed on the payer agendas as they are not being resolved through the normal dispute process.
Identification and communication of payer trends that are negatively impacting the overall AR.
Timely and professional communication with outside departments to resolve the billing or follow-up challenges.
Identification of department trends that need to be brought to Management to address with the departments.
Build an understanding of expected reimbursement on the accounts to ensure correct payments are received.
Build an understanding of the reports provided by leadership as it pertains to the assigned task or assignment.
Other duties as assigned.