Join a dynamic healthcare finance team as a Senior Billing Analyst, where you will play a crucial role in managing customer billing, collections, and accounts receivable processes. This position requires a detail-oriented professional with a strong understanding of medical insurance claims and payer contracts.

Essential Responsibilities

• Process medical insurance claims for assigned payers, ensuring accurate follow-up to final reimbursement.
• Maintain working knowledge of payer contracts, member co-pays, deductibles, co-insurance, and eligibility requirements to verify remittance advices.
• Respond to payer denials related to diagnosis and procedure codes or contractual issues, ensuring necessary information is transmitted for payment processing.
• Analyze and report repetitive denials to management, recommending corrective actions.
• Resolve account discrepancies including credit balances, payment transfers, audits, corrected claims, and insurance over/under payments.
• Communicate with insurance payers to resolve patient account issues.
• Document all actions taken on patient accounts within the accounting system.
• Ensure all required billing documentation is complete and follow up with physicians as needed.
• Generate billing statements, submit accurate claims, and file secondary or tertiary insurance claims for co-payments and deductibles.
• Prepare and submit manual and electronic claims daily.
• Collect payments promptly and resolve payment issues.
• Respond professionally to customer inquiries.
• Adhere to privacy and security regulations regarding Protected Health Information (PHI).
• Maintain effective communication and professional relationships with patients, team members, physicians, and external agencies.

People Management

This role does not include direct people management responsibilities.

Education and Experience

• High school diploma or GED required.
• 3-5 years of experience in facility billing, with recent Medicare insurance billing experience.
• Strong knowledge of Medicare policies, including Medical Necessity, LCD/NCD, and the Medicare website and Learning Network.
• Experience with insurance follow-up on DDE/C-SNAP.

Preferred Qualifications

No additional preferred education or certifications required.

Skills and Abilities

• Excellent writing, computer (Microsoft Word, PowerPoint, Excel), and database management skills.
• Strong customer service and problem resolution abilities.
• In-depth knowledge of Medicare rules and regulations, including the 72-hour rule.
• Familiarity with insurance terminology, claims processing, and explanation of benefits.
• Effective communication and phone skills.
• Basic computer knowledge and 10-key proficiency.

Physical Requirements

Light work with occasional exertion up to 25 lbs and frequent exertion up to 10 lbs. Standing or walking may be required 11-25% of the day.

Work within a supportive environment serving a broad regional community in the Central United States, dedicated to delivering exceptional care and service.