Position Summary

The Billing & Insurance Analyst I is responsible for daily operations related to the billing of primary and secondary claims and insurance follow up for their assigned location(s); coordinates with staff to ensure timely billing and follow up for claim denials. The Billing & Insurance Analyst I will ensure all adjustments are minimal and accurate. The analyst will assist with identifying trends, account reconciliation, and answering questions related to billing.

Major Duties and Responsibilities

• Investigate insurance denials and make necessary corrections to bring claim resolution.
• Ensure the correct primary and/ or secondary insurance was billed
• Prepare and submit appeals and or medical records to insurance companies
• Assist with identifying trends, aberrations and concerns related to billing and payer denials and communicates concerns to management.
• Ensure that payments and adjusted are posted per the EOB
• Responsible for running detailed A/R reports
• Work with the coding team to resolve coding related denials
• Respond to correspondences from payers in a timely manner.
• Assist patients with phone inquiries related to billing.
• All other duties as requested by the Manager.

Knowledge, Skills and Abilities

• Knowledge of insurance payers, including commercial and government payers.
• Analytical and problem solving skills to allow efficient resolution of insurance payment issues.
• Knowledge of electronic health record.
• Knowledge of insurance follow-up to ensure proper reimbursement.
• Ability to use website based insurance systems.
• Knowledge of Microsoft Office applications.
• Knowledge of medical terminology
• Ability to work scheduled hours as defined in the job offer.
• Ability to establish/maintain effective working relationships with multiple departments.
• Ability to read and understand oral and written instructions and follow written protocols.
• Effective communication.
• Ability to work independently.
• Time management skills

Education / Training / Requirements

• High school diploma or college degree
• Experience in medical billing and/or claims follow up

Physical Demands

• Ability to stand and walk for limited periods of time.
• Ability to sit for extended periods of time.
• Ability to climb or balance for limited periods of time.
• Ability to occasionally reach, bend, stoop and lift up to 30 lbs. *
• Ability to grasp and hold up to 25 lbs.*
• Ability to hear normal voice level communications in person or through the telephone.
• Ability to speak clearly and understandably.
• Ability to smell.

Success Factors

• Alignment with Company Mission and Core Values
• Excellent Time Management/Organized
• Open Communication/Positive
• Goal Driven
• Excellent Customer Service
• Juggles Multiple Priorities
• Accuracy and Attention to Detail
• Accomplished in word processing and worksheet utilization

All statements are essential functions of the position unless identified as non-essential by an asterisk (*).