Billing Analyst II

• Handle high level billing tasks, including complex medical claims, appeals, and disputed charges.
• Review and verify claim information for accuracy, completeness, and adherence to payers for reimbursement.
• Utilize comprehensive understanding of claim denials to conduct appropriate claim follow-up on all open A/R to ensure prompt adjudication.
• Ensure accuracy of billing data and compliance with local, state, and federal regulations, as well as payer -specific regulations.
• Assist in the development and implementation of policies, procedures, and workflows to improve efficiency.
• Work closely with coding, front office, clinical teams, and third-party vendors to resolve billing discrepancies and denials.
• Creation of claim projects with insurance companies and follow through on projects to ensure resolution.
• Provide guidance, mentorship, and supervision of reimbursement specialists.
• Perform daily ERA, EOB, and patient payment posting.
• Reconcile payments posted in Epic to banking deposit logs.
• Submit invoices for participating grant programs.
• Submit daily electronic and paper claim files, and correct all claim and charge review edits, warnings and errors; run statement files; and download ERAs/EOBs as needed.
• Review and monitor clearinghouse claim errors and global payer rejections for possible system edits or payer updates.
• Prioritize workflow for reimbursement specialists to ensure the revenue cycle team is completing all necessary tasks.
• Daily review of billing work queues.
• Credit balance review and processing
• Insurance benefit verification.
• Analyze payer denial trends and payer coding requirements to ensure payment of claims.
• Ensure month-end activities are completed in a timely manner and that month-end reconciliation is accurately completed.
• Ensure the affiliate's claim KPIs are satisfied.
• Participate in Revenue Cycle Team meetings/conference calls, and provide the necessary reporting, feedback, and training required to improve processes.
• Serve as an active agent on the billing line.
• Attend PPMW and PPFA training as well as other assigned training to improve knowledge base and claim efficiency.
• Follow up on denied claims with payers.
• Patient statement processing.
• Assistance with credentialing related inquiries and updates.
• Complete special projects as needed.
• Other responsibilities as assigned.

• Bachelors degree preferred, high school diploma or equivalent required
• Three or more years' experience in medical billing and/or Accounts Receivable
• Epic experience preferred.
• Experience with patient billing and collections.
• Access to secure, reliable Internet and utilities.

Planned Parenthood