Billing Optimization Analyst

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Act as the subject matter expert for the entire hospital claim-generation process, encompassing final coding, charge capture, claim creation, validation, and transmission.

• Investigate and resolve intricate billing edits, claim splits, bill holds, rejections, late charges, stop bills, and other exceptions that hinder the release of claims.

• Interpret and implement billing requirements for Medicare, Medicaid, managed care, and commercial payers in complex or non-standard scenarios.

• Examine ongoing claim barriers and identify root causes related to processes, system configurations, payer regulations, and upstream workflows.

• Facilitate working sessions with billing leaders and team members to discuss billing scenarios, present findings, and agree on resolution steps and responsibilities.

• Collaborate with operational, clinical, reimbursement, coding, IT, and vendor teams to enhance edits, work queues, workflows, and escalation procedures.

• Track first-pass clean-claim rates, bill-hold durations, DNFB, rejection trends, and billing throughput to ensure sustained improvements and uncover further opportunities.

• Create billing guidance, standard operating procedures, and training based on root-cause analyses to prevent future occurrences and ensure team consistency.

• Counsel billing and client leadership on billing risks, priorities, and the financial implications of recommended adjustments.

• Utilize, safeguard, and disclose patients’ PHI strictly in compliance with HIPAA regulations.

• Comprehend and adhere to Information Security and HIPAA policies and procedures.

• Limit access to PHI to the minimum necessary for completing assigned tasks.

• Carry out additional responsibilities as assigned.

⛳️ Requirements

• A bachelor's degree in healthcare administration, business, finance, or a related discipline; an equivalent combination of education and progressive hospital billing experience will also be considered.

• Over 4 years of progressive hospital billing experience, including direct resolution of complex claims prior to submission and leading the resolution of recurring billing challenges.

• Advanced understanding of the complete institutional claim lifecycle, including claim edits, split-billing scenarios, bill holds, rejections, late charges, stop bills, and corrected or replacement claims.

• Extensive knowledge of Medicare, Medicaid, managed care, and commercial payer billing regulations, claim formats, and submission protocols.

• Proficient understanding of UB-04 and 837I requirements, revenue codes, bill types, condition and occurrence codes, modifiers, claim frequency codes, and payer-specific edits.

• Proven capability to identify root causes, guide cross-functional teams through performance improvement initiatives, and maintain results while operating with a high level of independence.

• Ability to analyze billing, edit, hold, and rejection data to identify trends and assess financial impact.

• Preferred experience with researching claim-generation issues within Epic Resolute or a similar patient accounting system.

• Preferred experience utilizing clearinghouse tools, payer portals, claim scrubbers, and reporting tools.

• Exposure to various hospitals, facilities, or payer environments is preferred.

• Proficiency in Microsoft Office Suite.

• Excellent interpersonal and influencing skills, capable of communicating and presenting findings at all organizational levels, including executive leadership.

• Strong problem-solving and creative skills, along with the ability to exercise independent judgment and make decisions based on precise and timely analyses.

• High integrity and dependability with a strong sense of urgency and results orientation.

• Exceptional written and verbal communication skills are mandatory.

• Must have a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes.

• Availability to work outside normal business hours for special projects.

• Occasional travel to client facility sites may be necessary.

🏝️ Benefits

• Occasional travel to client facility sites may be necessary.

• Availability to work outside of normal business hours to support special projects.

• A smartphone or electronic device capable of downloading applications will be provided/required for multifactor authentication and security purposes.