About the position
Baptist Health is seeking a Billing Analyst to manage the billing system for both the Central Billing Office and the Professional Billing Office. This role is crucial in ensuring that accounts are billed accurately in compliance with regulatory requirements, such as managing outpatient overlaps and adhering to the Medicare three-day payment window. The Billing Analyst will be responsible for reconciling accounts and providing quality assurance across various patient accounting systems utilized by the hospitals and associated provider-based entities. In addition to billing management, the Analyst will prepare detailed analyses and reports for leadership that cover various aspects of hospital and provider-based billing. This includes monitoring edits, denials, regulatory changes, clean claim rates, payer acceptance rates, and measuring performance against both internal and industry-standard key performance indicators (KPIs). The role also involves ensuring the accurate and timely completion of any Electronic Data Interchange (EDI) and Electronic Remittance Advice (ERA) enrollments as required by payers. The Billing Analyst will perform quality assurance related to claims billing across multiple systems to ensure compliance with regulatory and provider-based requirements. Collaboration with Application Coordinators and IT is essential for reviewing and testing edits and changes applied to systems such as 3M, STAR, and Cerner, which are integral in passing claims data. Staying current with payer and regulatory changes is vital, as the Analyst will be responsible for distributing this information to management and recommending necessary adjustments to meet compliance requirements. Additional duties may be assigned as needed to support the department's objectives.
Responsibilities
- Manage the billing system for the Central Billing Office and Professional Billing Office.
- Ensure accounts are billed accurately according to regulatory requirements.
- Reconcile accounts and provide quality assurance across various patient accounting systems.
- Prepare analysis and reports for leadership related to hospital and provider-based billing.
- Monitor edits, denials, regulatory changes, clean claim rates, and payer acceptance rates.
- Measure performance against internal and industry-set KPIs for billing.
- Ensure accurate and timely completion of EDI and ERA enrollments as required by payers.
- Perform quality assurance related to claims billing across multiple systems.
- Collaborate with Application Coordinators and IT to review and test edits and changes in billing systems.
- Stay current with payer and regulatory changes and distribute information to management.
Requirements
- High school graduate or equivalent required; college degree preferred.
- Minimum 3-5 years of hospital healthcare experience or medical office billing experience required.
- Knowledge of payer, governmental, and provider-based billing regulatory requirements required.
- Experience with PC and billing systems is necessary.
- Knowledge of coding rules and requirements preferred; CPAR preferred.
- Strong analytical problem-solving skills are essential.
- Excellent organization and time management skills.
- Ability to establish priorities and manage workload effectively.
- Self-motivated and capable of working without direct supervision.
- Dependable in both production and attendance.
- Ability to work effectively with a wide range of customers in a diverse environment.
- Strong interpersonal and public relations skills.
- Proficient in PC applications, including Word and Excel.
- Strong oral and written communication skills.
- Willingness to assume additional duties as department needs dictate.
- Ability to maintain a professional and customer-centric composure in challenging situations.
- Knowledge of HIPAA standards and regulations.
- Familiarity with federal, commercial, and managed care payers.
- Ability to operate concurrently within various hospital systems.
- Ability to work collaboratively with managers and other areas within the system.
Nice-to-haves
- Knowledge of coding rules and requirements
- CPAR certification
