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About the Role

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 focuses on the timely follow-up of accounts needing re-billing, accounts with no payer response within regulatory guidelines, or denials requiring immediate action and rebuttal. The incumbent must demonstrate a quick learning ability, work independently, and utilize payer websites to locate relevant policies. They are expected to meet production standards after training and maintain effective communication with peers, trainers, and leaders.

Responsibilities

Resolve intricate billing edits requiring an understanding of initial claim issues and rebilling requirements.
Follow up on 'No Response WQs' by communicating with payers via phone, email, or website platforms.
Locate denial or remittance information via payer websites.
Respond to account denials by re-billing claims with updated information or submitting appeals with supporting documentation.
Collaborate professionally with internal or external departments to resolve edits or denials, including consistent communication with coding and other departments.
Identify and present payer trends among claims editing for similar reasons, working with leaders to mitigate these trends.
Serve as a resource to Medical Billing Associates as needed.
Identify payer trends within denials and work with leaders to mitigate them, aiming to minimize aging AR.
Maintain proper and detailed notation of actions taken on accounts.
Navigate payer websites to obtain information, review, understand, and locate payer policy guidelines.
Locate claim adjudication details with supporting documentation.
Proficiently use Epic, On Base, and other necessary platforms.
Work independently under time constraints and deadlines with minimal supervision, prioritizing workload effectively.
Begin to articulate possible avenues to resolve claim challenges.
Meet daily/weekly productivity standards with acceptable QA results.
Identify accounts needing placement on payer agendas when not resolved through the normal dispute process, focusing on AR > 60 days.
Communicate payer trends negatively impacting overall AR.
Communicate professionally with outside departments to resolve billing or follow-up challenges.
Identify department trends needing escalation to Management for addressal with departments.
Build an understanding of expected reimbursement on accounts to ensure correct payments.
Build an understanding of reports provided by leadership pertaining to assigned tasks.

Requirements

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 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.

Skills

Medical Billing
Claims Knowledge
Payer Website Navigation
Epic
On Base
Microsoft Office
Communication
Prioritization
Problem-Solving

Location

Albany Med Health System

Work Type

Day Shift

Experience Level

Intermediate

Education Level

High School Diploma/G.E.D.
Associate's Degree

Salary/Compensations

$46,947.00 - $65,726.00

About the Company

Albany Medical Center is an equal opportunity employer.
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.

Equal Opportunity

Albany Medical Center is an equal opportunity employer.
Albany Med Health System is an equal opportunity employer.