Billing Account Analyst

Job Description

JOB SUMMARY

The Billing Account Analyst is a vital member of the Billing and Claims team, responsible for researching, analyzing, and resolving account variances and claim denials, with a strong emphasis on coding accuracy and billing compliance. This role involves comprehensive review of insurance carrier policies, coding guidelines, contractual obligations, and benefit coverage to ensure precise claim submission and maximize reimbursement.

The Billing Account Analyst leverages critical thinking and problem-solving skills to navigate complex billing scenarios, often exercising independent judgment in the absence of clearly defined policies or procedures. Success in this position requires a deep understanding of coding standards, billing regulations, and payer requirements, as well as the ability to collaborate effectively with internal teams and external payers.

ESSENTIAL JOB FUNCTIONS

Researches, interprets, and applies applicable coding and billing requirements to ensure accurate and compliant claim submission.

Reviews and corrects diagnosis and billing codes, resubmitting claims as needed for reconsideration.

Identifies and analyzes denial reasons, working with carriers to obtain clarification and determine corrective actions.

Investigates complex claim variances using payer rules, coding guidelines, and benefit information to resolve outstanding issues.

Monitors and evaluates payment trends, recommending process improvements to optimize reimbursement.

Completes timely follow-up on assigned work queues to maintain an efficient revenue cycle.

Escalates unresolved or systemic issues to management, providing detailed research and supporting documentation.

Maintains current knowledge of CPT, CDT, and ICD coding standards, as well as healthcare billing regulations, to ensure high-quality claim processing.

Travels to FHC centers approximately 10% of the time; remaining work is performed from a remote or home office.

Performs other duties as assigned.

EDUCATION AND EXPERIENCE

1. High school diploma or equivalent

2. Successful completion of the following courses, per departmental procedures, within one year of hire (preferred, upon hire):

Medical, Dental, Behavioral Health: diagnosis, code on dental procedures and nomenclature (CDT) and medical terminology.

Billing and Claims - Professional: diagnosis, current procedural terminology (CPT) and medical terminology.

Billing and Claims - Facility: diagnosis and medical terminology.

3. Two years of experience in a medical business office, healthcare, or pharmaceutical setting, or equivalent experience.

Equal Employment Opportunity

Hybrid position. Monday thru Friday; 8am - 5pm

40

Full-time

Hybrid remote