Medical Billing and Claims Analyst

About the role

This role covers the administration, analysis and audit of the billing process, including accounts receivable management, payment reconciliation and collections from medical plans. It also involves reviewing denied or rejected claims and working with healthcare providers to reduce past-due balances.

Key responsibilities

• Review all documents received from the Customer Service Department and generate and coordinate the submission of all 1500 forms.
• Support aging and payment reconciliation, and prepare aging reports with collection notes and comments for follow-up.
• Support the claims process and analysis, including denied and rejected cases, and support collections to medical plans.
• Conduct audit reviews of all required healthcare providers and visit them regularly to follow up on payments, claims, outstanding balances, underpayments and discrepancies.
• Work according to assigned collection plans to achieve DSO goals and reduce past-due balances over 90 days.
• Prepare status and collection reports and work with the Billing & Collections Supervisor on other assigned duties.

Required profile

• Bachelor's degree.
• At least 2 years of experience working with medical plans and healthcare providers.
• At least 2 years of experience in the claims process.
• Knowledge of denied/rejection codes and ability to define effective action plans to meet collection goals.
• Microsoft Office knowledge.
• Medical Billing & Coder certification.