About this role
The Billing analyst is responsible for monitoring and analyzing the accuracy and integrity of the various aspects of the billing/reimbursement process. Responsible for analyzing billing laws and contract regulations to ensure the most efficient billing of third-party payers by Springfield Clinic, and completing projects involving analysis of denials, billing errors, and reimbursement questions.
Job Relationships
Reports to the Billing Compliance Manager
Principal Responsibilities
Note: Following duties will be assigned at the direction of the Billing Compliance Manager; because of multiple staff at position all of the following duties may not be assigned to a specific staff member per the work plan of the Billing Compliance Unit.
- Work on research projects as assigned towards proper reimbursement by third-party payers.
- Analyze Medicare and Medicaid regulations and assist in education efforts for providers and staff towards compliance with these rules.
- Analyze contractual insurance plans towards assurance that Springfield Clinic receives reimbursement as defined in various contracts and fee schedules.
- Work on projects as assigned towards overall billing compliance with all laws and regulations. Perform Compliance Audit Reports as assigned with follow-up reporting to Patient Accounting Coding and Billing Oversight Committee and/or Springfield Clinic Compliance Committee.
- Provider education projects and responsibilities as assigned. Could involve face-to-face meetings, educational memos, participation in orientation sessions, etc.
- Assist in maintaining pre-submission claim editing systems and analysis projects resulting from reports of that system as assigned.
- Analyze monthly insurance denial reports as assigned.
- Serve as occasional backup, as needed, to other Billing Compliance Unit staff members
- Comply with the Springfield Clinic incident reporting policy and procedures.
- Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
- Provide excellent customer service and adhere to SC Way customer service philosophy.
- Other duties as assigned.
Education/Experience
- High School graduate or GED required; college preferred.
- Minimum three (3) years of insurance billing/review work required.
Knowledge, Skills and Abilities
- Strong analytical and communication skills.
- Proficiency using software applications to perform job duties.
- Ability to work independently on assigned duties with minimal supervision.
- Ability to further knowledge of laws and regulations by continuing education efforts (reading manuals/subscriptions/newsletters; attending in-services and educational conferences).
- Manual dexterity required for use of calculator and computer keyboard.
Working Environment
- Working in high stress area that may involve handling angry customers.
- Some amount of travel, typically locally required.
- Requires sitting and standing for periods of time working in an office environment.
PHI/Privacy Level
HIPAA1