Billing Analyst

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