Billing and Claims Analyst / FT

Schedule: FT, Mon - Fri, flexible 8:00 am - 5:00 pm

At Children’s, the region’s only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly engaged, caring team—and join us in providing brighter, healthier tomorrows for the children we serve.



Children's is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.



A Brief Overview
Analyzes professional and/or technical claim errors and rejections for potential issues that delay claim submission and processing; collaborates with IT to improve claims production and minimize rejections to improve first pass yields and to gain efficiencies for electronic and paper claims production. Assists with higher level daily billing and editing of electronic and paper claims to ensure every claim is accounted for and billed successfully to insurance companies and patients. 

Essential Functions

• Analyzes electronic and paper claims and rejections for potential issues that delay claim production. Seek opportunities to optimize workflow and processes to enhance the patient and employee experience.
   
  • Analyzes claims daily or through reports to ensure payer-specific billing requirements are met for all electronic and paper claims.
  • Monitor clearinghouse and system rejections for all electronic and paper claims to identify areas for system enhancements or fixes, aiming to improve efficiencies and to prevent ongoing rejections.
  • Assists in time of backlog with the processing of claims and rejections by entering into system, moving to appropriate bucket, and directing to appropriate area for resolution. Ensures late charges are filed per payer and timely filing guidelines. Request additional information from appropriate staff members when needed.
  • Corrects claim errors within the system assigned to the analyst or within the dashboard, within established timeline of receipt, resolving bill/claim holds on accounts.
  • Assists Billing Specialists by answering inquiries, reviewing account issues, and providing updates on accounts as necessary.
  • Reconciles the daily claim tracker to ensure Clearinghouse and system reports are balanced, promptly addressing any reconciling items.
  • Reconciles third-party vendor claim reports with system reports to ensure are balanced, promptly addressing any reconciling items.
  • Identify coverages through monthly paper claim reports to refer to coverage committee for coverage builds. Participates in monthly coverage meetings to discuss new payer requests and concerns.
  • Identifies possible billing edits and rejection trends and reviews findings, when necessary, with supervisor prior to submitting tickets to IT for system improvements.
  • Maintains detailed and organized documentation on all findings and recommendations.
  • Collaborate with CBO leadership and IT on findings to improve claims production and first pass yields.
  • Continually seek improvement in systems, workflows and processes to eliminate the need for manual intervention and/or paper claims.
  • Files all claims in accordance with Central Billing Offices policies and procedures.
  • Have a thorough understanding of clearing house and EHR systems to assure accurate claim edits.
• Keeps current on payor requirements though workshops, newsletters, websites and other electronic tools (Experian).
   
  • Reviews government and payor manuals website, and communications for existing and new specific claim requirements for all electronic and paper claims.
    
    Complies with Federal and State billing requirements. Also complies with Health Information Portability and Accountability Act (HIPAA) and Electronic Data Interface (EDI) transaction formats.
• Other duties as assigned by leader and organization.

Education Qualifications

• Associate's Degree in billing, coding, business, finance, or related field. Required or
• Equivalent relevant work experience may be substituted for education Required

Experience Qualifications

• Minimum 4 years of experience working with professional and/or hospital insurance billing and claims Required

Skills and Abilities

• Organized, self-motivated, and able to work independently of direct supervision to carry out responsibilities
• Knowledge of hospital and professional billing, collection and reimbursement requirements and standard practice.
• Ability to review, interpret and understand managed care contracts with third-party payors.
• Intermediate computer skills including the use of spreadsheet programs and word processing programs.
• Strong interpersonal skills with attention to detail and ability to organize, interpret, and present data.
• Excellent oral and written communication skills as this position will deal directly with the public daily.
• Excellent interpersonal communication and organizational skills, pleasant attitude and proven ability to work effectively with others

Licenses and Certifications

Children’s is the very best for kids and the very best
for your career! At Children’s, we put YOU first so together, we can
improve the life of every child!