Medical Billing Associate - Saratoga Hospital

Medical Billing Associate

The Medical Billing Associate is a position located within the Hospital or Physician Billing Offices. The role is centered around the timely and efficient billing and follow up of medical claims throughout the Albany Med Health System (AMHS). This role focuses on pre-billing edits as well as some introductory payer denials. Claims must meet the regulatory requirements as well as specific payer policies. The edits are in place to ensure that clean claims are sent to the payers. Introduction to denial resolution is also part of this role. Initiating an appeal or rebilling the claim to address the denial is paramount to receiving payment. 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.

Essential Duties and Responsibilities

• Resolve all billing edits found in the assigned WQs.
• Respond to denials received on accounts as assigned. This may require a re-billing of a claim after updating the correct information or it may require the initiation of a dispute or appeal to the payer.
• Collaborate professionally internally or with external departments when needed to resolve the edit or denial.
• Recognize payer trends amongst the claims that are editing for similar reasons. Communicate those trends to leaders within the department to determine if a systematic update is required.
• Identify payer trends within the denials and work with leaders to mitigate those denials where possible. Goal to minimize aging AR.
• Proper and detailed notation of actions taken on the account. Others will rely on those notes when taking the next step on the account follow up.
• Payer Website navigation as needed to obtain information. Review, understand, and locate payer policy guidelines for billing or denial resolution.
• 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. to prioritize workload in an effective manner.
• Meet daily/weekly productivity standards with acceptable QA results.
• Other duties as assigned.

Qualifications

• High School Diploma/G.E.D. - required
• Associate's Degree - preferred
• Prior office experience - preferred
• 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
• CCS-Certified Coding Specialist Certified Inpatient Coder (CIC) or Certified Outpatient Coder (COC) Upon Hire - preferred

Equivalent combination of relevant education and experience may be substituted as appropriate.

Thank you for your interest in Albany Med Health System!?

Albany Med Health System is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:

Access to information is based on a "need to know" and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.