Medical Billing and Collections Analyst

VSG Business Solutions•Cary, NC

1d•Hybrid

About The Position

The Medical Billing and Collections Analyst reports to the Manager of Billing and Administration and supports Biologics by McKesson locations in Cary, NC, Fort Worth, TX, and Clermont, KY. This individual contributor is responsible for accurately and timely processing medically billed claims, researching and resolving claim denials and unpaid balances, supporting collection activities, and completing related invoicing and administrative transactions. The Analyst works closely with Operations, Payer Access, Cash Applications, Account Management, Compliance, and Finance to improve billing accuracy, accelerate reimbursement, maintain effective controls, and support the revenue cycle across Oncology, Rare & Orphan, and Cell & Gene product lines.

Requirements

3+ years of medical billing, healthcare collections, claims follow-up, denial management, or related accounts receivable experience in a high-volume environment.
High school diploma or equivalent required.
Experience working with commercial, government, or other healthcare payers and resolving denied, rejected, or unpaid claims.
Claims processing knowledge
Medical billing and insurance A/R experience
Denial and rejection management
Insurance follow-up and collections
Understanding EOBs/ERAs
Insurance verification and authorization knowledge
Accuracy and attention to detail
Communication and problem-solving skills

Nice To Haves

Associate or bachelor's degree in business, finance, accounting, healthcare administration, or a related field preferred.
Experience with Waystar and/or CareTend
Specialty pharmacy, biologics, oncology, rare/orphan disease or Cell & Gene therapy billing experience
Experience with high-dollar or complex medical claims
Underpayments experience
Chargebacks, invoicing, or reconciliation
Excel/reporting skills
CPC, CPB, CRCR, or another billing/revenue-cycle certification

Responsibilities

Prepare, review, and submit medically billed claims through CareTend and WayStar in accordance with payer requirements and established procedures.
Verify patient, insurance, authorization, coding, and supporting documentation information before claim submission; correct identified errors promptly.
Monitor claim status, aging, denials, rejections, and underpayments; research root causes and complete timely follow-up, correction, resubmission, reconsideration, or appeal activities.
Contact payers, patients, and internal partners as appropriate to resolve outstanding balances and document all collection activity accurately.
Support manufacturer chargeback activities by preparing invoices, submitting required documentation, monitoring payment status, and resolving discrepancies.
Process billing and invoicing transactions associated with the Exelan VA Lenalidomide program and other assigned programs.
Reconcile claim, remittance, payment, adjustment, and account information across applicable systems; escalate variances that cannot be resolved within established guidelines.
Maintain complete and accurate account notes, work queues, appeal records, payer correspondence, and supporting documentation.
Complete assigned administrative functions, including patient statement distribution, incoming mail review, and routing checks or other payments to the designated lockbox process.
Follow internal controls, policies, standard operating procedures, payer requirements, privacy standards, and compliance expectations.
Track productivity, quality, denial, collection, and aging metrics; prepare recurring reports and communicate emerging trends or barriers to the Manager of Billing and Administration.
Identify recurring billing or collection issues and recommend practical process improvements that increase accuracy, efficiency, and reimbursement.
Provide responsive, customer-focused service while collaborating with patients, payers, manufacturers, Operations, Payer Access, Cash Applications, Account Management, Compliance, Finance, and other support teams.
Support additional Accounts Receivable, billing, collection, and special-project activities as business needs evolve.