The Billing Optimization Analyst is the subject matter expert responsible for identifying and permanently resolving barriers that prevent accurate and timely claim submission. This role applies expert knowledge of Medicare, Medicaid, managed care, and commercial payer requirements across the claim-generation lifecycle, including edits, claim splits, bill holds, rejections, late charges, and other exceptions.
The analyst works independently to diagnose root causes, partner with billing, IT, and operational teams to implement fixes, and ensure issues do not recur. The role also supports performance improvement efforts by monitoring clean-claim rates, bill-hold days, DNFB, rejection trends, and billing throughput, then translating findings into sustainable process improvements.
Bachelor’s degree in healthcare administration, business, finance, or a related field, or an equivalent combination of education and progressive hospital billing experience.
- 4+ years of progressive hospital billing experience, including hands-on resolution of complex claims before submission and recurring billing issues
- Advanced knowledge of the end-to-end institutional claim lifecycle, including claim edits, split-billing scenarios, bill holds, rejections, late charges, stop bills, and corrected or replacement claims
- In-depth knowledge of Medicare, Medicaid, managed care, and commercial payer billing rules, claim formats, and submission requirements
- Strong working knowledge of UB-04 and 837I requirements, revenue codes, bill types, condition and occurrence codes, modifiers, claim frequency codes, and payer-specific edits
- Ability to identify root causes, lead cross-functional performance improvement efforts, and work with a high degree of independence
- Ability to analyze billing, edit, hold, and rejection data to identify trends and quantify financial impact
- Experience with Epic Resolute or a comparable patient accounting system preferred
- Experience using clearinghouse tools, payer portals, claim scrubbers, and reporting tools preferred
- Exposure to multiple hospitals, facilities, or payer environments preferred
- Proficiency in Microsoft Office Suite
- Strong interpersonal, influencing, written, and verbal communication skills
- Strong problem-solving and decision-making ability
- High level of integrity, dependability, urgency, and results orientation
Location
New Jersey, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
No
Posted
1 week ago