medical billing analyst

Department/Unit: Physicians Billing Work Shift: Day (United States of America) Salary Range: $46,947.00 - $65,726.00 Job Description Summary 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 of 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. Essential Duties and Responsibilities Resolve the more intricate billing edits as assigned. The edits are the result of claims that have previously been billed and require an increased ability to understand what happened initially and the additional requirements that are needed to rebill successfully. Follow up on the No Response WQs as assigned. Communicate with the payer via phone, email, or website platforms as needed. Locate denial or remittances via the payer websites as needed. 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 submission of an appeal with supporting documentation. Collaborate professionally internally or with external departments when needed to resolve the edit or denial. This may require consistent communication with coding or individual departments. For those that have coding certifications, the collaboration with coding will be complementary and beneficial to both areas. Identify and present the payer trends among the claims that are edited for similar reasons. Communicate and work with the leaders to mitigate. The expectation is that this role can work all billing edits and will serve as a resource to the Medical Billing Associate as needed. Identify payer trends within the denials and work with leaders to mitigate those denials where possible. The goal is to minimize the aging AR. Provide proper and detailed notation of actions taken on the account. Navigate payer websites as needed to obtain information. Review, understand, and locate payer policy guidelines as required. Locate claim adjudication details with the supporting documentation. Proficient use of Epic, On Base, and other platforms as needed. Work independently under time constraints and deadlines with minimal supervision. Prioritize workload effectively. Begin to articulate possible avenues to resolve claim challenges. Meet daily/weekly productivity standards with acceptable QA results. Other duties as assigned. Revenue Cycle Management Identify accounts that need to be placed on the payer agendas as they are not being resolved through the normal dispute process. Focus on accounts receivable aging > 60 days. Identify and communicate payer trends that negatively impact the overall AR. Maintain timely and professional communication with outside departments to resolve billing or follow‑up challenges. Maintain consistent and responsive communication with Patient Access and Coding. Identify department trends that should be brought to Management for addressing with the departments. Participate as needed and at the request of leadership, including practices, hospital departments, and other revenue‑cycle departments. Build an understanding of expected reimbursement on accounts to ensure correct payments are received. Build an understanding of reports provided by leadership as it pertains to the assigned task or assignment. Qualifications High School Diploma/G.E.D. – required Associate’s Degree – preferred Prior office experience – preferred Medical Billing or claims knowledge – preferred Ability to work independently and within a team Excellent verbal and written communication skills Ability to communicate with internal peers and leadership Demonstrates 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 Benefits Excellent health care coverage with no copay at Albany Medical Center providers A wide array of services and programs to support emotional, physical, and mental wellbeing Employment Equity Albany Med Health System is an equal opportunity employer. Confidentiality & Data Protection 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. #J-18808-Ljbffr