Billing Optimization Analyst – Hospital

🔥 12 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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Med-Metrix

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2010

🏥 Healthcare

☁️ SaaS

💰 Private equity on 2025-09

Healthcare • SaaS

Med-Metrix is a company for which only a minimal web presence was provided (the page only displayed "Loading application... Your web browser must have JavaScript enabled... "). No product, market, or mission details were included in the supplied text. Based on the company name alone, it plausibly focuses on medical or clinical metrics, analytics, or healthcare software, but that is speculative and not confirmed by the provided information. Further public details would be required to be more specific.

📋 Description

• Support the hospital claim-generation lifecycle, from final coding and charge capture through claim creation, validation, and transmission • Research and resolve billing edits, claim splits, bill holds, rejections, late charges, stop bills, and other exceptions that delay claims from being released • Apply Medicare, Medicaid, managed care, and commercial payer billing requirements to support accurate and timely claim submission • Analyze recurring claim barriers and help identify root causes across processes, system configuration, payer rules, and upstream workflows • Collaborate with billing leaders and team members to review billing scenarios, share findings, and recommend practical resolution steps • Partner with operational, clinical, reimbursement, coding, IT, and vendor teams to support improvements to edits, work queues, workflows, and escalation processes • Monitor first-pass clean-claim rate, bill-hold days, DNFB, rejection trends, and billing throughput to identify improvement opportunities • Document billing scenarios, root causes, recommended actions, and reusable guidance to support team consistency

🎯 Requirements

• 2–3 years of hospital billing experience, including hands-on experience resolving claims before submission • Working 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 • Knowledge of Medicare, Medicaid, managed care, and commercial payer billing rules, claim formats, and submission requirements • Familiarity with UB-04 and 837I requirements, revenue codes, bill types, condition and occurrence codes, modifiers, claim frequency codes, and payer-specific edits • Ability to research why a claim cannot be released, identify the appropriate resolution or escalation path, and clearly explain the next action to team members and stakeholders • Proficiency in Excel and comfort reviewing billing, edit, hold, and rejection data for trends • Clear written and verbal communication skills with a collaborative, consultative approach to problem-solving • Experience researching claim-generation issues in Epic Resolute or a comparable patient accounting system • Experience using clearinghouse tools, payer portals, claim scrubbers, and reporting tools • Exposure to multiple hospitals, facilities, or payer environments • Experience sharing billing guidance or helping team members work through claim issues • Must possess a smart-phone or electronic device capable of downloading applications for multifactor authentication and security purposes • Ability to follow directions, collaborate with others, and handle stress